Advanced Communication Engine (ACE) for UnitedHealthcare Electronic Claims – 10.20.2017October 20, 2017 10:08 am
Last updated on October 20th, 2017 at 10:08 am CT
Advanced Communication Engine (ACE) Applied to UnitedHealthcare Electronic Claims
Per notice from the payer, UnitedHealthcare has activated additional front end edits to be applied to commercial, professional claims (837P) submitted to Payer ID 87726. This change is effective as of 10/19/17.
All front-end editing, both HIPAA and ACE, will use the claim acknowledgment transaction (277CA) as the mechanism to send the edit messages to providers through our clearinghouse. ACE edits will indicate claims information that may not be accepted by UnitedHealthcare. This includes, but is not limited to, clinical code combinations using industry sourced guidelines, correct coding initiative (CCI) rules, validation of code sets and modifier use.
Since ACE editing occurs prior to the claim being delivered to UnitedHealthcare’s adjudication systems, providers will have the opportunity to review, correct and modify their claim submission by responding to the edit message. Providers may also resubmit the claim with its original content and it will be delivered to UHC.
All claims returned with ACE edits must be resubmitted to enter UnitedHealthcare’s claim adjudication system for processing. This process should result in providers experiencing fewer denied claims and reduced revenue cycle time.
The following ACE edits are being applied (for more details, view the ACE Edits online):
EDIT – DESCRIPTION
BDS – Missing or Invalid Date of Service Code
BPS – Missing or Bad Place of Service (POS)
CAG1/CAG – Inappropriate Procedure Age
CDL – Deleted Procedure Code
CPT – Disabled, Invalid or Missing Procedure Code
CSX – Procedure Not Typical with Patient Gender
DOB – Missing Patient’s Date of Birth
GSD – Global Follow-Up by Department or Specialty
GSP – Surgical Global Follow-Up – Same Provider
IAG – Diagnosis Not Typical for Age
IDX – Nonspecific Diagnosis Code
ISX – Diagnosis Not Typically Performed for Person of the Patient’s Gender Without Modifier KX
PAT – Missing Patient ID
PRS – Missing or Invalid Provider Specialty
PRV – Missing Provider ID or Department ID
PSX – Missing Patient Gender
TLS 1.2 Update – Revised FAQs – 08.31.2017 – Upgrade Due October 31, 2017October 19, 2017 11:10 am
Last updated on October 19th, 2017 at 12:31 pm 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.
Discontinued, DMC Care Eligibility – 10.19.2017October 19, 2017 10:25 am
Last updated on October 22nd, 2017 at 10:25 am CT
Effective immediately, DMC Care Eligibility is no longer available through Experian Health.
We apologize for any inconvenience this may cause.
Tentative Notice – Scheduled Processing Interruption – Thursday, November 9, 2017October 19, 2017 9:57 am
Last updated on October 19th, 2017 at 12:40 pm CT
Tentative Notice – Scheduled Processing Interruption – Thursday, November 9, 2017
During our scheduled maintenance Thursday, November 9, 2017, from 10:00p.m. to 11:59p.m. CT. there will be a two-hour downtime for all Patient Access, Financial Services, Coverage Discovery, and other core products. Due to the scale of this change, some clients may also expect 60-minutes of processing slowness to occur early Friday, November 10, between 12:00a.m. and 1:00p.m. CT. We apologize in advance for any inconvenience this may cause.
Reminder – Data Services, Scheduled Downtime – Wednesday, October 25, 2017October 18, 2017 11:29 am
Last updated on October 19th, 2017 at 11:51 am CT
Reminder – Data Services, Scheduled Downtime – Wednesday, October 25, 2017
On Wednesday, October 25, 2017, between 1:30p.m. CT and 4:00p.m. CT. our Data Services team we will perform a database upgrade. During this time, certain reports on the Reporting Portal will not be available and includes Eligibility, PaymentSafe, Authorizations, and Notice of Admission. We have scheduled the time of this upgrade such that it does not interrupt any nightly processes and to reduce any impact this may cause. Please understand that the impact of this upgrade represents only a very limited number of our clients, if any, that may be affected. We apologize in advance for any inconvenience.
CMS Medicare HETS 270/271 Scheduled Outage – Saturday, October 21-22, 2017October 18, 2017 11:16 am
Last updated on October 19th, 2017 at 12:34 pm CT
CMS Medicare HETS 270/271 Scheduled Outage – Saturday, October 21-22, 2017
CMS announced an upcoming outage to the Medicare HETS 270/271 eligibility system. CMS data center maintenance will begin at 11:30 PM ET on Saturday, October 21, 2017. The HETS 270/271 system will be unavailable during this period. Attempts to open a connection to the HETS 270/271 application will result in errors. CMS estimates that the maintenance window will be completed by 8:00 AM ET on Sunday, October 22, 2017.
New Arkansas Medicaid Enterprise MMIS – Eligibility – 10.16.2017October 16, 2017 4:30 pm
Last updated on October 16th, 2017 at 04:30 pm CT
New Arkansas Medicaid Enterprise MMIS – Eligibility – 10.16.2017
The Arkansas Department of Human Services (DHS) will have a new Arkansas Medicaid Management Information System (MMIS). The new MMIS will bring cutting edge technology to DHS, Arkansas Medicaid providers and beneficiaries.
Go-live of the new Medicaid Management Information System for trading partners is scheduled for October 26, 2017. According to the payer, eligibility files in the legacy MMIS will be kept up-to-date through October 20, 2017. Eligibility verification is still available; just be aware after October 20 there will be no updates made to the legacy eligibility files. All current eligibility files will be available on October 26.
Be sure to keep record of eligibility checks during this time. If you have proof of positive eligibility, according to the payer the claim will not deny for eligibility. If your patient says they are eligible but the system says they are not, then contact Arkansas Medicaid PAC call center for more eligibility information by calling 501.376.2211, option 0 and then option 2.
Scheduled Maintenance, Hi-Def Benefit Rules Servers – Wednesday, October 18, 2017October 11, 2017 11:21 am
Last updated on October 12th, 2017 at 11:28 am CT
Scheduled Maintenance, Hi-Def Benefit Rules Servers – Wednesday, October 18, 2017
Experian Health will perform a duplicate “rollover” of our Hi-Def Benefit Rules Servers on Wednesday, October 18, 2017, between 11:30p.m. and 12:30a.m. CT (Thursday, October 19). During this time, our Benefit Rules Servers will be offline. Please understand that this maintenance represents only a very limited number of our clients being affected, if any. However, in the event you experience potential transaction issues with Patient Estimates, Alerts, or Payer Content, please contact our support team at email@example.com.
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)
New Arkansas Medicaid Enterprise MMIS – Claims and Remits – 10.05.2017October 5, 2017 2:07 pm
Last updated on October 16th, 2017 at 02:19 pm CT
Please be advised that because of the changes the Arkansas Department of Human Services (DHS) will be making, the payer has stated that any Provider IDs that are currently associated to our current Trading Partner ID to receive remits will be transferred and linked to our new Trading Partner ID.
To verify if your NPI has been linked to our new Trading Partner ID, please contact AR Medicaid at 501-376-2211, Option 0 and then Option 1 and ask if your NPI is linked to Trading Partner ID # our new TPID is TP010786.
New Arkansas Medicaid Enterprise MMIS – Claims and Remits – 10.05.2017
The Arkansas Department of Human Services (DHS) will have a new Arkansas Medicaid Management Information System (MMIS). We are pleased to announce that our trading partner enrollment application in new MMIS system has been accepted and approved by the State.
The new MMIS will bring cutting edge technology to DHS, Arkansas Medicaid providers and beneficiaries. Go-live of the new Medicaid Management Information System for trading partners is scheduled for October 26, 2017. Deadline to Submit Claims to process in the legacy system is October 20 @ noon CST. We encourage all providers to submit their claims early in the morning in order to make the cut off time. Any claims received after will be held in our system and on October 23, 2017, claims will be submitted to the new system but will be held by Arkansas Medicaid for processing until October 26, 2017. Normal processing will occur in the new system on October 26, 2017.
Early registration for the new HealthCare Provider Portal is open. Arkansas Medicaid providers can register for portal access and assign delegate access now. (HTML, new window). All provider portal functionality will be available after Go-live of the new MMIS on November 1, 2017!
Registering for access and assigning delegates proper access are a provider’s first steps to begin using the new healthcare provider portal. We encourage providers to attend training sessions to understand the portal registration process and delegate access options covered in the workshops. Training will help ensure your success with the new provider portal. For more specific information about provider changes, please visit https://www.medicaid.state.ar.us/provider/frontline.html.
Please note Arkansas Medicaid requires linkage to our new Trading Partner ID to receive remits, it is not a requirement to send claims. During registration, we attempted to link Provider IDs we are currently receiving remits for to our new Trading Partner ID. Please carefully review and ensure that all your Provider IDs are linked to our new Trading Partner ID to avoid any disruption of remit delivery.
For reference, Experian Health is registered within Arkansas Medicaid Management Information System (MMIS) systems as shown below:
Trading Partner ID: TP010786
Trading Partner Name: Experian Health, Inc.
720 Cool Springs Blvd
Franklin, TN 37067
Experian Health will continue to post notices on the ClaimSource Dashboard, which can be accessed by providers at http://www.experianhealthproductdashboard.com under the heading “New Arkansas Medicaid Enterprise MMIS”