Contract Manager Medical Groups
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
Contract Manager Suite: CMS Updates for Physician and Hospital Fee Schedules, RBRVS, Hospital Outpatient Prospective Payment System including Work Expense GPCI’sMarch 2, 2018 11:53 am
Last updated on March 12th, 2018 at 07:34 pm CT
Experian Health has postponed the revalue of 2018 RBRVS claims that was scheduled for March 9, 2018. In light of additional retroactive updates that will be deployed soon, we felt it prudent to identify the potential impact of those and avoid the need for a second mass revalue.
We will update the dashboard with details when this is rescheduled.
Experian Health Key Contact 03/02/2018
CMS published 2018 updates for the Physician and Hospital Fee Schedule, RBRVS and the Hospital Outpatient Prospective Payment System. Experian Health has ensured that your Medicare contract records have been updated and available in Contract Manager, Contract Analysis, Patient Responsibility Pricer, Patient Estimates and Claim Scrubber.
Because CMS has made some of the updates retroactive to January 1, 2018, valuations for Contract Manager, Patient Responsibility Pricer, Patient Estimates and Claim Scrubber will begin using the new Work Expense Geographic Practice Indices indicated by CMS. The Work Expense GPCI’s for localities with a value below 1.0 have been raised to the floor of 1.0. Please note not all Carriers or localities were affected.
Please be aware that Contract and Procedure Code Analysis generated previously may need to be re-generated to use to the revised Work Expense GPCI values for 2018 in affected localities. Patient Estimates and Patient Responsibility Pricer Estimates previously created may need to be re-valued to use the revised Work Expense GPCI values for 2018 in affected localities. The retro updates to GPCI impact Claim Scrubber Edit # 1009 – Expected Amount is Greater than the Charge Amount. The updates may populate more undercharges as the Expected Amount will be higher.
The physician conversion factor of $35.9996, a hospital conversion factor of $35.9996 and a national anesthesia conversion factor of $22.1887 remain in effect. In addition, valuations for Contract Manager for Hospitals and Health Systems will use the latest published wage indices, APC weights and rates and fee schedules.
There are also RVU changes that impact all clients regardless of locality, so any claims with Date of Service since January 1, 2018 valuing with 2018 RBRVS should be revalued. Experian Health will execute a revalue of all such professional claims in Contract Manager for Medical Groups beginning Friday, March 9, 2018 at 4:00pm CT.
The Experian Health team will be capturing claim lists as well as pre and post revalue snapshot data that can be made available after the revalue upon request. If you or your team does need access to this data, please open a support case and we will make the data available via the support case and assist in analysis as needed.
If you do NOT want Experian Health to revalue your claims, please notify us via support case by end of day Thursday, March 8.
If you choose to revalue your own claims before March 9, there is no need to contact us and those claims will not be captured in our process to identify those claims last valued before these retroactive updates were deployed.
As always, Experian Health will continue to monitor for any subsequent changes published by CMS and update accordingly.
Thank you for your continued partnership and business,
Experian Health Client Support
GPCI Table Updates and Related Actions: Contract Manager Suite, Claim Scrubber, PRP, and Patient Estimates 2.28.2018February 28, 2018 2:26 pm
Last updated on March 16th, 2018 at 01:47 pm CT
Experian Health Key Contact 02/28/2018
On Tuesday 2/27/2018 Experian Health encountered a Geographic Practice Cost Indices (GPCI) table issue that has been resolved.
The error occurred at 9:59 AM CT and corrected at 11:48 AM CT, when normal processing returned.
This impacted Contract Manager, Contract Analysis, Procedure Code Analysis, Patient Responsibility Pricer, Claim Scrubber and Patient Estimates.
As a precaution and to ensure proper valuation of all potentially impacted claims, Experian Health will be revaluing all effected Contract Manager claims that were valued during the time window.
Claim Scrubber transactions that were processed during this time window will also be reprocessed to ensure patient history files are complete.
If your organization performed Patient Estimates or Patient Responsibility Pricer estimates during this time window you may want to reprice those estimates if you have not already done so.
If a Contract or Procedure Code Analysis was running during this time period you may opt to rerun them for proper valuation if your contracts use RBRVS fee sources.
We apologize for any inconvenience this may have caused for your team.
Please forward as appropriate within your organization.
Experian Health Client Support