ClaimSource Release Notes – 01.18.2018January 19, 2018 12:02 am
Last updated on January 19th, 2018 at 12:02 am CT
- Work Queues – During your session, ClaimSource will retain your current work queue filter when you tab away from the work queue until you change it or reset it.
- Work Queues – Claims work queue filter now allows searching by Occurrence Code, Occurrence Span Code, Condition Code and Value Code.
- Work Queues – Denials work queue now has the option to view the work queue by alerts or by claims.
- Work Queues – Users can now create remittance work queue profiles for payments
- Work Queues – Payments work queue now shows new column for payer name
- Claim Maintenance – New ability to force a claim to restatus from the status detail screen
- Claim Maintenance – Uploaded documents can now be marked as attachments and can be submitted electronically with claims to specific payers.
- Error Map Setup – New filter for selecting criteria for the Error Map list
- Payer Setup – The ability to filter on submission method has been added
- Reports – New RAC recoupment summary report
For detailed information on these features, please see the document at the link below:
Contract Manager Suite UAT Environment Offline – 1.17.18 – ResolvedJanuary 17, 2018 9:31 am
Last updated on January 20th, 2018 at 03:48 pm CT
9:45 AM CT – The UAT environments are back online. Root case is being investigated.
The UAT environment for the Contract Manager Suite (Claim Scrubber, Contract Manager, Patient Responsibility Pricer, Payer Alerts) is currently off line. Technical teams are aware and working to restore connectivity ASAP. We do not have and ETA at this time and further updates will follow.
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.
Aetna ERA File Delivery for Wed. Jan. 3, Delayed – 01.03.2018 – UpdateJanuary 5, 2018 9:00 am
Last updated on January 12th, 2018 at 12:46 pm CT
The ETA for ERA file delivery is approximately 1:30p.m. ET.
Aetna ERA file delivery for today, Wednesday, January 3, 2018 is delayed. An update communication will be sent once we have an ETA.
Claimsource, eCare CMS and ERA – Page Errors and Slowness Issues – 01.04.2018 – ResolvedJanuary 5, 2018 8:22 am
Last updated on January 8th, 2018 at 08:52 pm CT
[1.4.18 10:50am CT] The issue has been resolved. We apologize for the inconvenience.
[1.4.18 10:25am CT] Technical teams continue to work on this as a top priority.
We will continue to post any additional information or updates here.
[1.4.18 9:25am CT] Technical teams continue to work on this as a top priority.
We will continue to post any additional information or updates here.
[1.4.18 8:25am CT] We are experiencing connection problems and our Experian network team is trying to isolate them and get them corrected.
We do not have an ETA at this time. We do apologize for the inconvenience – and we will post updates here as become available.
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