Cigna 835/ERAs Delays, from 12/27/2017 – 01.17.2018, UpdateJanuary 12, 2018 9:43 am
Last updated on January 17th, 2018 at 11:31 am CT
62308 – CIGNA
Cigna continues to have ERA processing delays affect the delivery of 835 files since 12/27/2017. As instructed by Cigna, a copy of the EOB associated with the missing ERA must accompany all research requests. As such, please be sure to provide Experian Health with a copy of the EOB when submitting requests, to allow us to obtain the missing ERA from the payer. Cigna continues to work toward a resolution to the issue and updates will be provided as they become available.
Please be advised that Cigna has identified a processing issue impacting some 835s from 12/27/2017. Cigna is working to resolve the issue. Updates will be provided as they are made available.
Changes for Sedgwick ERA Process and Delivery – 01.11.2018January 11, 2018 11:41 am
Last updated on January 14th, 2018 at 11:42 am CT
Please be advised that Sedgwick is in process of changing their ERA/EFT vendor. Providers will need to post manually using the paper EOB received or visit Smart Data Solutions quick claim portal, to download the PDF image of the ERA.
Efforts to resolve the issue are ongoing. There is no ETA for resolution at this time.
The Smart Data Solutions Provider Portal (requires the provider’s username and password)
New Mailing Address – Blue Cross Community Health Plans – 01.08.2018January 8, 2018 9:15 am
Last updated on January 8th, 2018 at 09:15 am CT
Please note the new mailing address for hardcopy Medicaid claims (XOG alpha prefix).
Blue Cross Community Health Plans
c/o Provider Services
P.O. Box 3418
Scranton, PA 18505
Please refer to the new Blue Cross Community Health Plans (BCCHP) manual available on the BCBSIL website for complete plan details.
Experian Health Payer Alerts Quarterly Update 01.03.2018January 4, 2018 9:58 am
Last updated on January 4th, 2018 at 09:58 am CT
We have posted a Payer Alerts Quarterly Update document to the Payer Alerts home page, and wanted to notify you of the important changes that may impact your organization. If you wish to modify your organization’s subscription based on any of these changes or additions, please submit a Support Case or contact your organization’s Self-Service Administrator or Subscription Management user to apply the updates.
- Aetna Better Health of California
- Aetna Better Health of Maryland
- TRICARE West/Health Net Federal Svcs (AK,AZ,CA,CO,HI,ID,IA (no Rock Island),KS,MN,MO (no St.Louis),MT,NE,NV,NM,ND,OR,SD,TX (WT TX only),UT,WA,WY)
- TRICARE East/ Humana Military (AL,AR,CT,DE,DC,FL,GA,IL,IN,IA (Rock Island),KY,LA,ME,MD,MA,MI,MS,MO(St.Louis),NH,NJ,NY,NC,OH,OK,PA,TN,TX (no El Paso),VT,VA,WV,WI)
Eight Payer name updates. Please note that the effective dates on these name updates vary.
Please refer to the Payer Alerts Quarterly Update document on the Payer Alerts home page as appropriate within your organization.
Indiana Health Coverage Programs (IHCP), New HCPCS Codes, Feb. 2, 2018 – 01.04.2018January 4, 2018 9:19 am
Last updated on January 12th, 2018 at 12:47 pm CT
Indiana Health Coverage Programs (IHCP), January 2, 2018
IHCP to cover HCPCS codes J0887 and J0888
Effective February 2, 2018, the Indiana Health Coverage Programs (IHCP) will cover the following Healthcare Common Procedure Coding System (HCPCS) codes:
- J0887 – Injection, epoetin beta, 1 microgram, (for ESRD on dialysis)
- J0888 – Injection, epoetin beta, 1 microgram, (for non-ESRD use)
Coverage applies to all IHCP programs, subject to limitations established for certain benefit packages, and to dates of service (DOS) on or after February 2, 2018. The following reimbursement information applies:
- Pricing: Maximum fee of $1.63
- Prior authorization (PA): None required
- Billing guidance:
- Separate reimbursement is allowed under revenue code 636 – Drugs requiring detailed coding for separate reimbursement in an outpatient setting. For reimbursement consideration, providers may bill the procedure code and the revenue code together, as appropriate.
- Must be billed with the National Drug Code (NDC) of the product administered.
These changes will be reflected in the Procedure Codes that Require NDCs and the Revenue Codes Linked to Specific Procedure Codes code tables on the Code Sets web page, and in the Professional Fee Schedule and the Outpatient Fee Schedule at indianamedicaid.com.
Reimbursement and PA information applies to services delivered under the fee-for-service (FFS) delivery system. Individual managed care entities (MCEs) establish and publish reimbursement, PA, and billing criteria within the managed care delivery system. Questions about managed care PA should be directed to the MCE with which the member is enrolled.
Providers may resubmit claims for CPT code 99292 that denied incorrectly
The Indiana Health Coverage Programs (IHCP) has identified a claim-processing issue that affects fee-for-service (FFS) claims billed for Current Procedural Terminology (CPT®1) 99292 – Critical care, Evaluation and management of the critically ill or critically injured patient, each additional 20 minutes. The issue affects claims retroactive to dates of service (DOS) on or after January 1, 2016. This issue was identified earlier and thought to be corrected, as noted in IHCP Banner page BR201724, dated June 13, 2017. Unfortunately, the system was not fully corrected and claims may have continued to deny inappropriately with one of the following explanations of benefits (EOB):
- Claims processed before February 13, 2017, in IndianaAIM may have denied with EOB 4190 – Add-on codes not payable when base code not billed.
- Claims processed on or after February 13, 2017, in CoreMMIS may have denied with EOB 6390 – Add-on codes are performed in addition to the primary service or procedure, and must never be reported as a stand-alone code.
A billing exception exists that should allow payment for CPT code 99292 billed by one provider when another provider of the same specialty in the same group practice billed for CPT code 99291 – Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes on the same DOS. In those instances, the claim for CPT code 99292 should adjudicate and pay rather than deny for the EOBs indicated. The claim processing system has now been corrected to allow this exception.
Beginning immediately, providers may resubmit claims for CPT 99292 that denied appropriately for EOB codes 4190 or 6390, for reimbursement consideration. Claims resubmitted beyond the original one-year filing limit must include a copy of this banner page as an attachment and must be filed within one year of the publication date.
1CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Railroad Medicare and J15 Part B Electronic Remits (835s), 1/3/2018 Unavailable – 01.03.2018January 3, 2018 10:28 am
Last updated on January 12th, 2018 at 12:50 pm CT
Due to a system issue with the payer, RailRoad Medicare and J15 Part B electronic remittances (835s) are not available for 01/03/18. We’ll post additional information as it becomes available.
Available Payer Lists and Payer Updates – 01.03.2018January 3, 2018 9:07 am
Last updated on January 4th, 2018 at 10:05 am CT
Click below to see the latest available payer lists (01.03.2018)
- Claims and Remits Payer List Updates_20180105
- Claims and Remits Payer List_20180105
- New Payers_Real Time_HIX_Claims_Remits_Workers Comp_20180102
- Payer Mnemonics_20180103
- Real Time Payer List_20180103
- Workers Compensation Payer List Updates_20180105
- Workers Compensation Payer List_20180105
Possible Eligibility Issues Occurring in the New Year – 2018December 28, 2017 10:00 am
Last updated on December 31st, 2017 at 10:01 am CT
Possible Eligibility Issues Occurring in the New Year – 2018
The beginning of a new year is a busy time for most insurance companies. Because of the large numbers of new plans and renewals, it can take the health plans several weeks to get their systems updated to reflect new plans and policy changes. Please allow the payer time to finish their updates before sending a case for data discrepancies regarding benefits or enrollment status. This includes the following type of issues:
• Responses showing previous year benefits
• Responses returned without benefit information
• Incorrect eligibility status
• Incorrect/old MCO data
• Incorrect/old PCP and IPA data
Many members have plan changes that start on 1/1/2018, which requires them to get a new card. Please confirm that the member has given you the most current card when checking eligibility. Requesting eligibility with an old ID number may result in “invalid subscriber ID” errors or old policy data being returned.
If you should run across instances in which the payer’s web portal shows the 2018 benefit information but the Experian Health eligibility response does not, please open a ticket with customer support and provide the following:
• Transaction Reference Number
• Full Screen shot of payer portal including URL
• A clear description of what information is incorrect on our eligibility response
BCBS Illinois Community Options, Name Change – Effective Jan. 1, 2018December 20, 2017 9:06 am
Last updated on January 12th, 2018 at 12:52 pm CT
BCBS IL COMMUNITY OPTIONS
Name Change Effective 1/1/2018
Please be advised that Blue Cross Community Options is changing its name to
Blue Cross Community Health PlansSM effective Jan 1, 2018.
All members will receive new cards reflecting the name change.
For details and additional information regarding this change, please refer to the December Blue Review
BCBS Illinois, Pre-Authorization Changes – Effective, Jan. 1, 2018 – 12.19.2017December 19, 2017 10:11 am
Last updated on January 12th, 2018 at 12:53 pm CT
2018 Pre-Authorization Changes
Effective Jan 1, 2018, BCBSIL is increasing the number of outpatient services requiring preauthorization. While preauthorization is not a new BCBSIL concept, it typically has not been required for most outpatient benefit categories in previous years.
This expanded utilization management initiative applies to all networks. However, the preauthorization contact entity will vary based on the type of policy and the services being rendered. To avoid claim denials, verifying patient eligibility and benefits is critical in order to confirm where/how preauthorization requests should be submitted.