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.
ClaimSource Release Notes – 03.15.2018March 15, 2018 11:08 pm
Last updated on March 15th, 2018 at 11:08 pm CT
- Roles – Ability to limit administrative permissions on a role and its children to a specific site or site group
- Roles – Administrative and general functionality permissions have been split into two separate lists
- User Setup – When adding a new user, the department ClaimSource is no longer displayed
- Reports – Activity filtering has been added to the Follow-Up Alert Detail and Summary Reports
For details, please see the document at the link below:
ClaimSource Release Notes – 02.15.2018February 15, 2018 9:04 pm
Last updated on February 15th, 2018 at 09:05 pm CT
ENHANCEMENTS AND CHANGES:
- Work Queue – For the claims view on the Claims and Denials work queues, the HIS Payer ID can now be displayed as an optional column. There is also an additional filter available for locating by HIS Payer ID in the Claims work queue.
- Work Queue – New filter for Subscriber ID/Policy Number.
- 837 Exports – 837 Export ISA segments are now uniquely numbered
- System Messages – When incomplete itinerary runs are restarted and completed, the name of the user that triggered the rerun is included in the completion message.
- System Messages – Reconcile counts now show additional counts for claims rejected during the reconcile.
- Claim Maintenance – The status detail screen can now be printed.
- Reports – Changes to report scheduling. See documentation link below.
Enhanced documentation at
ClaimSource Release Notes – 02.01.2018February 1, 2018 10:52 pm
Last updated on February 1st, 2018 at 10:52 pm CT
- Work Queue – New batch print to PDF function allows users to choose up to 20 claims to combine in a single PDF file.
- Work Queue – A limit of 2000 claims is now enforced when exporting claims in 837 format.
- Claim Maintenance – Users with special permissions can now edit sent claims without having to reset them.
- Claim Maintenance – Professional claims now allow editing Supervising Physician at the charge level.
Detailed information can be found at the document link below:
WPS Intermittent Processing Issues with Electronic Transactions – 02.27.2018 – ResolvedJanuary 30, 2018 2:17 pm
Last updated on March 2nd, 2018 at 03:30 pm CT
WPS has made available all existing Tricare East ERA files and the files have now been posted in eCare. We continue to work closely with WPS to ensure that these issues have been permanently resolved.
WPS- Manages the Tricare Health Plans. Issues continue as outlined below. We continue to work with WPS to resolve these issues.
We have received reports and are aware of widespread, intermittent processing issues at WPS. This may impact several different types of the electronic transactions, and affecting multiple trading partners and providers. Transaction types that we have identified with this intermittent problem include:
- Enrollment for Remits
- Missing Remits
- Claim Processing Delays
- 276/277( we continue to work with WPS to implement this transaction).
Experian Health continues to work closely with WPS in an effort to remedy these issues and will provide additional updates as they become available. For additional details, please visit the WPS website at: http://www.wpsic.com/edi/edi-news/1801-edi-issue.shtml
For providers needing assistance with claims and/or ERA enrollment, please contact our Enrollment Team at email@example.com
BCBS IL, OK, NM, and TX – ERA 835 Delays for 1/19/2018 – 01.23.2018January 23, 2018 11:19 am
Last updated on January 29th, 2018 at 12:25 pm CT
1/25/18 – The issue with ERA delivery delay has been resolved. Missing files/vouchers have been received and processed
Please be advised that Blue Cross Blue Shield is reporting delays in ERA delivery starting on 1/19/18. There is no ETA for resolution at this time. This could impact 835 delivery for the following states: IL, OK, NM & TX. We apologize for the inconvenience and will post updates as they are received from the payer.
UnitedHealth Group, EDI Claims Rejecting Error, New Procedure Codes, 1/1/2018 – ResolvedJanuary 23, 2018 9:11 am
Last updated on February 5th, 2018 at 07:14 pm CT
[02.02.2018] Now resolved.
Claims with these procedure codes, effective January 1, 2018, will now process as normal.
EDI Claims Rejecting in Error for Procedure Codes effective 1/1/2018
Our trading partner and UnitedHealth Group have identified an issue that is causing electronic data interchange (EDI) claims with new procedure codes (CPT, NDC, HCPC) effective on January 1, 2018 to reject in error. The error message will reflect Code is not a valid CPT or HCPCS Code for this Date of Service.
UnitedHealth Group will have all January 1 effective codes available for claims to process on February 2, 2018. At this time, we would recommend halting submission of EDI claims with new procedure codes effective January 1, 2018 until the codes are updated for processing use on 2/2/18. Claims with procedure codes effective before January 1, 2018 will process as normal.
ClaimSource Release Notes – 01.25.2018January 22, 2018 4:26 pm
Last updated on January 29th, 2018 at 12:16 pm CT
The following ClaimSource payer rules will be released to production Thursday, 1/25/18:
- First Choice Health Network, Payer ID 91131 – All Claims – Group# is required. (https://www.fchn.com/documents/ppo/providers/ppoprovidercontractedproviders/20170323-providermanualv20171.pdf)
- Traditional Medicare Institutional Outpatient Screening Mammograms – For services before 1/1/2018 – CPT 77063 must be billed with HCPC G0202. For services on or after 1/1/2018 – CPT 77063 must be billed with CPT 77067. (MM10181).
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:
ClaimSource – IHCP (Indiana Medicaid) to mass adjust or mass reprocess certain claims that adjudicated incorrectly in CoreMMIS – 12.21.17December 21, 2017 8:49 am
Last updated on January 12th, 2018 at 12:52 pm CT
The Indiana Health Coverage Programs (IHCP) continues to evaluate claims processed through the CoreMMIS system to make certain all claims have been adjudicated correctly. The IHCP has identified some claim-processing issues that affect a variety of Current Procedural Terminology (CPT®1) and Healthcare Common Procedure Coding System (HCPCS) codes. For complete details, please refer to BR201751 on the payer’s website.