Maintenance Saturday 10/21: 5:00 AM – 8:00 AM CT – Contract Manager Suite, Claim Scrubber, Payer Alerts 10.16.2017October 16, 2017 6:50 pm
Last updated on October 16th, 2017 at 06:51 pm CT
The Experian Health Engineering team is planning a maintenance window for very early Saturday, 10/21/17. This will impact Experian Health Contract Manager, Claim Scrubber, Patient Responsibility Pricer, and Payer Alerts. The applications will be unavailable and real time Scrubber and HL7 transactions unable to be processed during this period. The exact time of the maintenance is:
Saturday 10/21/17 5:00 AM to 8:00 AM CT
Additional information prior to and during this event will be here.
This maintenance has been intentionally scheduled during off-peak hours, but we do apologize for any inconvenience this event may cause for your team.
Please forward as appropriate within your organization.
Experian Health Client Support
Blue Cross Illinois Advantage and Community Options, PCP/IPA, Not Returning – 10.16.2017October 16, 2017 11:26 am
Last updated on October 16th, 2017 at 11:26 am CT
Blue Cross Advantage and Community Options are currently not returning the PCP/IPA information in the eligibility response. We have notified BCBS of IL of this issue and well provide updates as we receive additional information from them.
TLS 1.2 Update – Revised FAQs – 08.31.2017 – Upgrade Due October 31, 2017October 12, 2017 11:10 am
Last updated on October 12th, 2017 at 11:30 am CT
Experian Health is focused on helping our customers improve their security by using the latest security protocols. On October 31, 2017, Experian Health will require TLS 1.2. At Experian Health, we take the protection of our customer’s data very seriously. The disablement of TLS 1.0 and 1.1 is being undertaken so we can maintain the highest security standards and promote the safety of your data as well as align with industry-wide best practices. You can read more about TLS 1.2 and see FAQs by clicking the link below.
Medical Necessity / Order Checker – Intermittent Slow Responses During Peak Usage – 10.11.17October 11, 2017 8:17 am
Last updated on October 14th, 2017 at 08:17 am CT
[10/11/17 8:00a.m. CT]
Medical Necessity / Order Checker – Intermittent Slow Responses During Peak Usage
The Experian Health technical teams are aware of an issue that is causing intermittent slow response times from Medical Necessity and Order Checker during periods of peak usage. The team has identified a possible root cause and is working on a solution at this time as a top priority. We do not have an ETA at this time. Any additional information will be posted here.
ERA 835 Delays, OPTUM, UHC (9/27-Current) – Multiple Payers – 10.10.2017October 10, 2017 2:02 pm
Last updated on October 13th, 2017 at 02:02 pm CT
Some 835’s for UnitedHealthcare from check date 9-27-17 through present are delayed. UnitedHealthcare continues to work on the issue and it has been escalated. However there is no ETA as to when the 835s will be delivered. Payer IDs include:
AARP Insured By UnitedHealthcare Insurance Company
UnitedHealthcare Community Plan AZ
UnitedHealthcare Community Plan CA, DE, FL, HI, LA, MA, MD, NM, OH, PA, VA, WA
UnitedHealthcare Community Plan NJ
UnitedHealthcare Community Plan NY
UnitedHealthcare Community Plan WI
UnitedHealthcare Community Plan KS
UnitedHealthcare Community Plan MO
UnitedHealthcare Community Plan MI
UnitedHealthcare Community Plan TX
UnitedHealthcare Community Plan NE
UnitedHealthcare Community Plan IA,MS,TN
UnitedHealthOne / Golden Rule
UnitedHealthOne All Savers Insurance (AMS)
ERA Processing Delays, Sept. 27-Oct. 1, Multiple Payers – 10.04.2017October 4, 2017 9:46 am
Last updated on October 7th, 2017 at 09:47 am CT
An interruption has been identified in normal Electronic Remittance Advice (ERA) processing and delivery for the following payers This impacts some ERA expected from these Payers for processing between 9/27/2017 through 10/1/2017. It results in delivery delays for the impacted ERA because the files from the Payer were not received.
Efforts to resolve this issue continue. It is currently open and in progress.
No action is required.
35145 – KEY FAMILY OF COMPANIES
04567 – UNITEDHEALTHCARE COMMUNITY PLAN / MD
NYU01 – UNITEDHEALTHCARE COMMUNITY PLAN / NYU
39026 – UMR – WAUSAU/UHIS
44054 – GOVERNMENT EMPLOYEES HEALTH ASSOCIATION (GEHA)
86047 – AMERICHOICE NJ MEDICAID
87726 – UNITEDHEALTHCARE
95378 – UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY
95959 – UNITEDHEALTHCARE WEST / PACIFICARE CA – 95959
96385 – KANCARE / UNITEDHEALTHCARE COMMUNITY PLAN – KS
UHC Eligibility Responses and Historical Plan Information – 09.14.2017September 14, 2017 12:18 pm
Last updated on September 17th, 2017 at 12:18 pm CT
UHC has recently started returning historical plan information for Medicaid members in their eligibility responses. We have notified the payer of this and they’re researching the root cause of this change.
United Health Care Service Type Code – Updates to 270/271 Eligibility Transactions, Sept. 15 – 09.14.2017September 13, 2017 3:44 pm
Last updated on September 16th, 2017 at 03:44 pm CT
We have identified a problem sending multiple Service Type Codes to UHC in one transaction. We are working with UHC to resolve. Once this issue is resolved we will notify you of a new release date.
On September 15th we will begin sending one (1) transaction with up to ten (10) Service Type Codes to UHC on behalf of our providers. Adjustments in both the FR and NE Clearinghouses are being made to support this change.
Two Important Items.
- We will no longer be charging a transaction for each service type code since we will be including up to 10 in one transaction.
- If a provider sends more than 10 Service Type Codes we will send more than 1 transaction. For example, if a provider sends 25 Service Type Codes we will send 3 transactions each with 10 Service Type Codes.
UnitedHealthcare will allow requests and return benefits for up to 10 service type codes (STC) for 270/271 EDI transactions starting September 15, 2017. This will give care providers access to more eligibility and benefit information for our members, with the ability to request the specific information they need in one 270 transaction, such as:
5 Diagnostic lab
30 Health plan benefit coverage
PT Physical therapy
AE Physical medicine
Physical therapy and specialist benefits will be available in September, both as a generic response and an explicit response. Generic responses are obtained by requesting STC 30 and will automatically include physical therapy and specialist benefits. Explicit responses are obtained by requesting the specific STC only, such as PT or 96. In most cases, a message segment will be returned when benefits are for a specialist.
New Medicare Beneficiary Identifier (MBI), April 2018 – Update 08.17.2017August 16, 2017 6:13 am
Last updated on September 11th, 2017 at 02:50 pm CT
[August 17, 2017]
Coming in April 2018: New Medicare Card – New Number
Medicare is taking steps to remove Social Security numbers from Medicare cards. In April 2018, people with Medicare will begin receiving new Medicare cards, replacing all cards by April 2019. These cards will have a Medicare Beneficiary Identifier (MBI) number that is randomly generated with “non-intelligent” characters. Once this change is effective, scheduled for April 2018, we will modify search criteria to support the new MBI. The transition period where both MBI’s and HICN numbers will both be available is now schedule to be for a 21-month period
Beginning April 2018, and throughout the 21-month transition period Experian will be supporting both the current HICN and the new MBI formats. Search options will allow for both ID’s. CMS advised us that if you use the HICN number the HICN number will be returned. If you use the MBI the MBI will be returned. They will not be returning both numbers in one transaction/response.
Railroad Retirement Board (RRB) Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA, will notice a change with the new cards:
- Providers will no longer be able to distinguish people with Railroad Medicare by the number on the card.
- The RRB will continue to send cards with the RRB logo to people with Railroad Medicare.
- CMS will return a message on the eligibility transaction response for a Railroad Medicare patient. The message will say, “Railroad Retirement Medicare Beneficiary” in 271 Loop 2110C, Segment MSG.
[May 31, 2017]
Below is an announcement that CMS released today. In order to provide you the most current information on the MBI change we will continue to update this post as we receive more information from CMS. Once this change if effective, scheduled for April 2018, we will modify search criteria to support the new MBI. The transition period where both MBI’s and HICN numbers will both be available is now schedule to be for a 21 month period.
New Medicare cards offer greater protection to more than 57.7 million Americans
New cards will no longer contain Social Security numbers, to combat fraud and illegal use
The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.
“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” said CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”
Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition
CMS testified on Tuesday, May 23rd before the U.S. House Committee on Ways & Means Subcommittee on Social Security and U.S. House Committee on Oversight & Government Reform Subcommittee on Information Technology, addressing CMS’s comprehensive plan for the removal of Social Security numbers and transition to MBIs.
Personal identity theft affects a large and growing number of seniors. People age 65 or older are increasingly the victims of this type of crime. Incidents among seniors increased to 2.6 million from 2.1 million between 2012 and 2014, according to the most current statistics from the Department of Justice. Identity theft can take not only an emotional toll on those who experience it, but also a financial one: two-thirds of all identity theft victims reported a direct financial loss. It can also disrupt lives, damage credit ratings and result in inaccuracies in medical records and costly false claims.
Work on this important initiative began many years ago, and was accelerated following passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will assign all Medicare beneficiaries a new, unique MBI number which will contain a combination of numbers and uppercase letters. Beneficiaries will be instructed to safely and securely destroy their current Medicare cards and keep the new MBI confidential. Issuance of the new MBI will not change the benefits a Medicare beneficiary receives.
CMS is committed to a successful transition to the MBI for people with Medicare and for the health care provider community. CMS has a website dedicated to the Social Security Removal Initiative (SSNRI) where providers can find the latest information and sign-up for newsletters. CMS is also planning regular calls as a way to share updates and answer provider questions before and after new cards are mailed beginning in April 2018.
eCare NEXT Patient Estimates Processing Errors – 10.17.2017 – RESOLVED – 1:30p.m. CTOctober 17, 2017 12:44 pm
Last updated on October 17th, 2017 at 02:00 pm CT
[1:30p.m. CT] The issue has been resolved and the system teams will continue to monitor. We apologize for the inconvenience.
[1:15p.m. CT] The issue appears to only be affecting Medicare estimates. Development teams are currently troubleshooting the issue.
Experian Health’s Technical team is working on the processing errors with eCare NEXT Patient Estimates. We will continue to post updates on this dashboard as they come. We apologize for the inconvenience.
NY Medicaid Eligibility Issues – 10.16.2017 – ResolvedOctober 16, 2017 11:55 am
Last updated on October 16th, 2017 at 03:56 pm CT
This issue has now been resolved.
We are actively working with NY Medicaid on a resolution for the eligibility issues. An update will be provided as soon as we know more.