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
Maintenance – Contract Manager Suite, Claim Scrubber, and Payer Alerts – Saturday, 10.21.2017, 5:00 AM – 8:00 AM CT – CompleteOctober 18, 2017 6:50 pm
Last updated on October 21st, 2017 at 07:01 am CT
[10.21.2017 – 7:00 a.m. CT]
Maintenance is complete.
[10.21.2017 – 5:30 a.m. CT]
Maintenance is underway.
The Experian Health Engineering team is planning a maintenance window on the morning of Saturday, October 21, 2017 between 5:00a.m CT and 8:00a.m. CT. During this time period, you will be unable to access Contract Manager, Claim Scrubber, Patient Responsibility Pricer, and Payer Alerts. Each of these applications will be unavailable. Our Real-Time Scrubber and HL7 transaction processing will also be unable during this time. We have scheduled this maintenance period to reduce any impact this may cause and we apologize in advance for any inconvenience.
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
ClaimSource Release Notes – 10.12.2017October 12, 2017 10:38 pm
Last updated on October 12th, 2017 at 10:38 pm CT
- Denials Work Queue – New filters added for diagnosis, procedure and DRG
- Reports – Renamed Payer ID to Transmit Code on “Filter by Payer” report filters to more accurately reflect the search criteria. For reports previously showing a Payer ID column, the column titled is also renamed to Transmit Code.
More information on these items is available by clicking the link below:
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”
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
ERA Processing Delays for CIGNA (62308) – Resolved [10.11.2017]September 29, 2017 9:57 am
Last updated on October 15th, 2017 at 04:44 pm CT
Institutional/Professional/Dental – Payer(s): 62308 – CIGNA
This has been resolved. Payer processing has returned to normal.
Please download any outstanding ERAs that may be affected by this issue.
Institutional/Professional/Dental – Payer(s): 62308 – CIGNA
An interruption has been identified in the normal Electronic Remittance Advice (ERA) processing and delivery for this payer. This impacts some ERAs expected for processing on 9/25/2017 through present. This will result in delivery delays for the impacted ERA because the files from the Cigna were not received. No action is required.
ClaimSource Release Notes – 09.28.2017September 28, 2017 9:21 pm
Last updated on September 28th, 2017 at 09:21 pm CT
- Denials Work Queue – CPT/HCPCS filter now allows range and wildcard searches (see documentation below for details)
- Denials Work Queue – New filter for finding payments with a specific reason code and CPT/HCPCS combination. CPT Range and wildcard searches can be used here as well.
- Reports – New report: Claim totals by provider
- Claims Work Queue – “Clean Claims” filter has been renamed “Claims Without Open Errors or Holds” to properly reflect the actual logic behind the search.
Click the link below to view the detailed documentation:
Connectivity Issue – Remits, Illinois Department of Public Aid – 09.29.2017 – ResolvedSeptember 28, 2017 2:03 pm
Last updated on October 2nd, 2017 at 06:54 pm CT
This issue has now been resolved and remit files are being downloaded.
We are experiencing connectivity issues when downloading remits from Illinois Department of Public Aid. Our team is currently working on resolving the issue and we will post an update as soon as the issue is resolved.
ClaimSource Payer Rules Released to Production – Thursday, Sept. 28, 2017 – 09.25.2017September 25, 2017 3:20 pm
Last updated on September 27th, 2017 at 11:56 am CT
The following ClaimSource payer rules will be released to production Thursday, 9/28/17:
- Excellus/BCBS (EDI codes SB804/SB805/SB806) – Professional Claims received after 8/3/17 require NDC codes for HCPCS codes J0000-J9999.
- Traditional Medicare Institutional Outpatient Claims – Attending Physician not allowed for emergency trips; HCPC codes A0427, A0429 – A0434, and A0428 with QL modifier.
- BCBS Michigan (ID Code 00210) – All Institutional claims must have an A3(primary), B3(Secondary) or C3(tertiary) value code https://www.bcbsm.com/content/dam/public/Providers/Documents/hipaa-edi-health-care-claim-institutional.pdf Page 18