WPS Connectivity/System Issues – Delayed ERAs, Claims – 04.19.2018 – Latest UpdateApril 18, 2018 3:25 pm
Last updated on April 19th, 2018 at 01:33 pm CT
[04.19.2018 01:30p.m. CT] Notice of Current Ongoing Issue:
WPS Connectivity/System Issues – Delayed ERAs and Claims – 04.19.2018 – Latest Update
WPS continues to work on identifying the root cause and resolution of the connectivity issues and
have now posted a message to the WPS EDI Website to notify users of the issue. WPS is also reviewing the process to be followed with respect to any timely filing issues, as they will vary per Line of Business. File transmissions To/From are still suspended at this time and we’ll continue to post updates as we obtain more information.
[04.18.2018 04:30p.m. CT]
We continue to have connectivity issues with WPS and WPS is still working to identify the root cause.
We’ve suspended file transmissions to/from WPS until they tell us the issue is resolved. (When we’ve
tried to connect to them today, we weren’t even able to get connected. If we can’t connect, we can’t
Please do NOT resubmit claims at this time. We’ve provided WPS with a list of all the claims that
show as ‘delayed’ so that they can tell us if they have them in their system or not.
We have another call scheduled tomorrow morning with WPS and will address the issue of timely filing.
The dashboard will be updated tomorrow with any new information received.
[04.17.2018 03:10p.m. CT]
In a recent update from WPS, they have not yet determined the root cause of the connectivity issues which are occurring. They have their system vendor and internal I.T. staff addressing the issue as their highest priority.
[04.17.2018 11:20a.m. CT]
We continue to have connectivity issues with WPS, which is resulting in delayed responses, delivery of ERA files, and claim transmissions. We are working closely with the payer in an effort to get them to resolve the issue and will post additional updates as more information becomes available.
WPS has acknowledged having gateway issues which are impacting multiple submitters, and have indicated that they are working on a resolution. We will continue to post updates as they are provided to us by WPS.
This post has been updated to also include Claim Responses. The ongoing connectivity issues with WPS have also resulted in delayed responses for claims sent to WPS from March 21st – present. We continue to work with WPS on this issue. Additional updates will be made to this post as more information becomes available.
We’re experiencing intermittent connectivity issues with WPS which is impacting delivery of ERA files for the following payers. We’re working with WPS to resolve the issue and will post additional information as it becomes available.
- Tricare: Tricare East, Tricare for Life, and Tricare Overseas
- TriWest VAPC3: Regions 3, 5A, 5B, and 6
- Medicare: Nebraska, Michigan, Missouri, Kansas, Iowa, Indiana, Part A National
Contract Manager – Sprint Release 7.0 Highlights, Deployment – April 18, 2018April 17, 2018 3:29 pm
Last updated on April 17th, 2018 at 04:16 pm CT
On Wednesday 4/18/2018, Sprint Release 7.0 will be deployed to Production. Detailed documentation of the changes are posted on the application home pages. We also wanted to remind you via this dashboard post of the important changes and updates, and ask that you please refer to the Highlights document for complete details.
Sprint Release 7.0 Highlights
- Client Self-Service Access for User Account Maintenance
- Evergreen Contract Renewal Email Reminders
- Modifiers to Unbundle Codes
Contract Manager for Medical Groups – Enhancements
- Special Rounding for Anesthesia
- Modifier GA or GY to Log Message #1066 logic
- Contract copy/update for Carveouts
- Payor Specific Edit 2012 for Enhanced Rate
- New YourCare Health Plan Appeal Letter Template
- New BlueCross BlueShield of Texas Corrected Claim Form Appeal Letter Template
- Cross Claim Valuation Tax ID
- Cross Claim LCD Changes
- Self-Service Tricare/Medicare remove option for Carve-Outs
Contract Manager for Hospital and Health Systems – Enhancements
- Claim Type Attribute for Epic ASC
- Millbrook ASC HIS Attributes
- View/Export Adjustment Code Mapping Tables
- Log Message 5315 update for outlier payment greater than zero
- Iowa Medicaid Inpatient Outlier Logic
Contract Analysis for Hospital and Health Systems – Enhancements
- Save Analysis Contracts to Multiple User Groups
- Contract Analysis Charge Master Increase Option
Claim Scrubber – Updates and Enhancements
- View/Export Contract Code Mapping Table
- Update: Warning Message for Data Table Import Name Length
- Edit and Exclusion Builder New Combination Condition
- Update: Code List Updates for Edits 6039 and 6040
Tricare, Message in Error – Primary Payer is Tricare East Contractor – 04.16.2018April 16, 2018 1:52 pm
Last updated on April 16th, 2018 at 01:52 pm CT
Tricare West has notified us that some members may be returning the following message in error:
“Primary Payer is Tricare East Contractor”
They’re currently working to fix this and hope to have it resolved before the end of April, 2018.
National Government Services (NGS) NPI Crosswalk Issue, EDI and DDE – 04.16.2018, UpdateApril 16, 2018 10:52 am
Last updated on April 16th, 2018 at 10:52 am CT
National Government Services is aware of a widespread issue with the National Provider Identification (NPI) crosswalk file that is causing a limited amount of providers to have Electronic Data Interchange (EDI) claim files to reject in error, causing issues with Direct Data Entry (DDE) claim submissions, and may affect eServices and EDI enrollment issues.
Affected providers will have issues with EDI and DDE claim submissions. In addition, providers attempting to enroll in eServices or EDI enrollment changes may also be affected. Affected providers should contact the Provider Contact Center (PCC) to report the issue. Once contact is made, please allow ten full business days for resolution. National Government Services will contact the provider once their issue is resolved.
Hospice providers may be granted exceptions for late NOEs due to this issue.
The cause of this nationwide issue has been escalated and is being researched. Updates will be provided as soon as they are available. No additional provider action, other than reporting the issue, is required at this time.
Delayed Claim Responses – 04.13.2018 at 6:00pm CTApril 13, 2018 5:59 pm
Last updated on April 16th, 2018 at 05:59 pm CT
Delayed Claim Response – One of our trading partners experienced a system issue which resulted in delayed claim responses. The issue impacts claims that were sent to the following payers from March 28 – April 10.
- Horizon New Jersey Health
- Western Oregon Advanced Health
- Memorial Herman Health
- Cox Health Plan
The issue is expected to be resolved next week and we will provide updates as they become available.
Delaware Medicaid (DMAP) – Claims Issue, Due to 2018 HCPCS Codes – 04.11.2018April 11, 2018 3:32 pm
Last updated on April 17th, 2018 at 03:45 pm CT
Delaware Medicaid (DMAP) – Claims
Attention: All Providers
Claims currently suspending due to new 2018 Healthcare Common Procedure Coding System (HCPCS) codes.
- DMAP is in the process of updating the new 2018 HCPCS codes with an effective date of 1/1/2018.
- DMAP will be processing these suspended claims in the near future.
- Claims included in this process are for dates of service beginning January 1, 2018 and forward.
- This information will appear on a future Remittance Advice (RA).
- There will be further communication regarding the timing of this update for dates of service 1/1/2018 and forward.
MA Medicaid Update – HSN Server Upgrade, Claims Submission – 04.11.2018 – UpdateApril 11, 2018 10:36 am
Last updated on April 11th, 2018 at 10:36 am CT
As you are aware, the HSN Server upgrade began in March to comply with the Massachusetts Executive Office of Technology Services and Security requirements. HSN has recommended that facilities continue the submission of claims during this Server upgrade. Facilities should continue submitting all 837I, 837P, 837D and POPS claims as well as Emergency Room Bad Debt (ERBD) recoveries and Free Care Endowment Income when applicable.
In addition, facilities are asked to use this time to work with the HSN Operations team to resolve any outstanding claims processing issues and/or HSN denials. Any questions can be directed to the HSN Helpdesk via email or by calling (800) 609-7232.
Rescheduled: Contract Manager and Claim Scrubber: Advanced Reporting Offline Thursday, April 26 for Server MovesApril 9, 2018 7:30 am
Last updated on April 18th, 2018 at 01:42 pm CT
4/18/1018 Update: Please note that the maintenance previously scheduled for Thursday, April 19, 2018 has been rescheduled for the following week, Thursday, April 26, 2018. Please see updated message below:
Experian Health technical teams will be relocating several servers on Thursday evening April 19, 2018.
This move will include the servers that provide the Advanced Reporting features of Contract Manager and Claim Scrubber.
This will require planned downtime for Advanced Reporting. The timing of this event will be as follows:
Thursday, April 26, 2018 – From 8:00 p.m. CT to April 27, 2018 2:00 a.m. CT (approx. 6 hours)
Advanced Reporting will be unavailable during this time.
Additional information, updates, and status before, during, and after the cut-over will be posted on this page.
Experian Health Client Support
Experian Health – Voice Your Concern to CMS About New MBIs – 04.04.2018April 4, 2018 12:41 pm
Last updated on April 7th, 2018 at 12:41 pm CT
Regarding the New Medicare Beneficiary Identification Project, Experian Health is providing you the opportunity to voice your concerns and send the attached recommended MBI Enhancement Request to CMS.
As we are all aware, the Medicare Beneficiary ID will be changing beginning in April 2018. While all of us advocate for Electronic Data Interchange standardization and compliance within the healthcare industry, there are some issues of which those who use Medicare’s eligibility system (HETS 270/271) should be aware. The current decision from CMS is that the MBI will be returned only on the eligibility response (271) if the MBI is used in the inquiry (270). CMS will require a provider to use a look up tool available through the individual MAC’s website when a provider cannot obtain the new MBI from the member. Additionally, CMS will be returning the MBI in the E1 NCPDP transaction (the pharmacy equivalent to the 270/271 transaction) if the HICN is submitted. Due to the complications this change will make to a provider’s workflow when registering a Medicare Beneficiary, we as an part of a larger EDI community have drafted a recommended enhancement request to CMS.
Please read the two links below that include a cover letter and instructions for the steps to follow to complete the attached template for the enhancement request to send to CMS. Experian Health has also sent this request to CMS.
(Previous Post - Reference) Last and Previous Posts: March 29, 2018 - Deadline Approaching – New Medicare Beneficiary Identifier (MBI) – Update Last and Previous Posts: March 22, 2018 - Reminder – New Medicare Beneficiary Identifier (MBI), April 2018 – Update Last and Previous Posts: March 9, 2018 - New Medicare Beneficiary Identifier (MBI), April 2018 – Update
[March 29, 2018]
April 2018 – New Medicare Beneficiary Identifier (MBI) – Update, 03.29.2018
The April, 2018 has arrived. Please click this headline and review the information posted on our product dashboard under the New Medicare Beneficiary Identifier (MBI) April 2018. Experian Health is ready to accept both the HICN and MBI in the X12 270/271 Transactions (Eligibility Inquiry/Eligibility Response). A new “My Response” coverage banner will also be added to within OneSource and eCareNEXT, Within the returned 271 Eligibility Response, we will return the message segment:
“CMS mailed a Medicare Card with a new Medicare Beneficiary Identifier (MBI) to the Member”
For Premium EDI clients, we have created an Epic EDI alert that will return the same message. (Similar to when a patient has limited coverage, or a Medicare Advantage/Medicaid MCO.)
Please Note: CMS will only return that message for beneficiaries that have traditional Medicare. If they’re enrolled in a Medicare Advantage plan, Medicare will not return this information.
WellCare Health Plan, Delayed Claim Response Issue – 04-13-2018 – UpdateApril 4, 2018 10:51 am
Last updated on April 16th, 2018 at 10:29 am CT
Experian Health has received and has updated the list of claims that were printed by our trading partner. Claims that were printed are marked as “sent”.
WellCare Health Plan – Our trading partner lost connection to WellCare Health Plan which resulted in delayed claim responses. Primary Claims sent to WellCare Health Plan (Payer code 14163) between March 21st and April 4th were sent on paper to the payer by our trading partner. All secondary claims were rejected, as the trading partner was unable to send them on paper.
- Claims in batched status – Providers will receive a list of claims that were sent on paper in the next few days. These claims will be marked as ‘sent’ by Experian Health as we will not be receiving electronic responses.
- Rejected secondary claims – Experian Health will provide a list of secondary claims that were rejected. Please resubmit the claims.
WellCare Health Plan – Our trading partner is experiencing connectivity issues with WellCare Health Plan (Payer ID 14163) which is resulting in delayed responses for claims sent after March 21st. They are working on resolving the issue and have not provided an ETA yet.