Maintenance: MPV Eligibility Portal and Patient Responsibility Pricer: Thursday 1/18/18 9:00 PM CT to Midnight [Complete]January 17, 2018 11:05 am
Last updated on January 20th, 2018 at 11:06 am CT
1/19/2018 12:09 am:
This maintenance event has been completed.
Experian Health will be performing maintenance on the legacy MPV Eligibility systems on Thursday night 1/18/18 from 9:00pm to Midnight.
The Eligibility Application including Real-Time and Batch processing will be unavailable during this time.
The Eligibility portions of Patient Responsibility Pricer requests will also be impacted during this time.
The time of this maintenance was selected to be off of core hours. We do apologize for nay inconvenience for your team members that are online at this time.
CMS Changes 271 Eligibility Response, Saturday, Nov. 18. – Update, 11.17.2017November 17, 2017 10:38 am
Last updated on November 27th, 2017 at 01:32 pm CT
CMS has updated the release of changes to the eligibility response( 271) on Saturday Nov 18th. Eligibility will not be available Saturday from 7:30 AM ET until 2:00 PM ET. Once the system is available you should see changes that include:
- Inclusion of QMB (Qualified Medicare Beneficiary) eligibility data
- Enrollment dates for QMB within calendar year or spell when dual eligible
- Hospital Days and Hospital Days Remaining
- SNF Days and SNF Days Remaining
- Part A Lifetime Reserve
- Financial preventative data no longer returned for dual eligible for the entire year
- Hospice Occurrence count only returned if Beneficiary has Part A entitlement
- Will return DOEBA and DOLBA dates for all hospital spells intersecting requested DOS and/or calendar year
- Two New MSP Insurance type codes (AP) auto insurance and (LT) litigation
- HCPCS Code Changes/Updates- HCPC code changes noted will be available December 8th.
- New Notification for Inactive/eligible- Initial Preventative Physical Benefit
- Preventative HCPCS codes report current coverage date instead of calendar year
- Additional HCPCS available for preventative care
The below links will provide the details.
Release Summary: https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/Downloads/R2017Q400HETS270271ReleaseSummary.pdf (version 1.06. Section 3.3 was updated; Section 3.8 was added)
We will be monitoring these changes and update this communication if there are any changes.
We have been notified by CMS that there is no release date for the below changes. Once we are notified of a release date we will update this message. There are some additional revisions to the original release. The changes are how QMB is now going to be returned in the 271 response. There are also changes to section 3.8. As we obtain more information, we will update this post.
This is currently pending and may be rescheduled for a later time by CMS. As necessary, we will post any updates when available.
CMS has notified us of changes to their 271 Eligibility response. These changes will be available in mid-November. Once we have a specific release date we will update this communication.
The changes being made by CMS are as follows:
- Preventive HCPCS Code Changes – HETS 270/271 will now only return Preventive HCPCS code information for the current date (and not the current calendar year).
- Newly Supported Preventive HCPCS Codes will now support the following Preventive Healthcare Common Procedure Coding System (HCPCS) codes: • 81528 • G0297 • G0442 • G0443 • G0472 • G0473 • G0475
- IPPE HCPCS Code Changes: HETS 271 responses may return Initial Preventive Physical Benefit (IPPE) Preventive HCPCS code information differently. The IPPE HCPCS codes (G0402, G0403, G0404, and G0405) may, in certain circumstances, return a 271 2110C EB loop indicating that the Medicare Beneficiary is ineligible for this service.
- Preventive HCPCS Code Financial Changes: HETS 270/271 will no longer return Preventive HCPCS code financial information for Qualified Medicare Beneficiary (QMB) periods when the Beneficiary is dual-eligible for both Medicare and Medicaid for the entire year.
- Updated Medicare Secondary Payer (MSP) Insurance Type Codes – HETS 270/271 will now return two additional Medicare Secondary Payer (MSP) Insurance Type Codes for applicable Medicare beneficiaries. The new codes that can be returned in the 2110C EB04 element are: • AP – Auto Insurance Policy – this indicates a No-Fault Medicare Set-Aside Arrangement (NFMSA) • LT – Litigation – this indicates a Liability Medicare Set-Aside Arrangement (LMSA)
- HETS 271s May Include Qualified Medicare Beneficiary (QMB) Data. HETS 271 responses will include a 271 2110C loop for applicable Beneficiaries to indicate periods during which the Beneficiary is enrolled in the Qualified Medicare Beneficiary (QMB) program. QMB-enrolled Beneficiaries are dually eligible for both Medicare and Medicaid. Beneficiaries who are enrolled in the QMB program are not liable for Medicare co-insurance or deductible payments. Submitters should note that when the 271 2110C EB04 = QM, the DTP segment will reflect only periods of QMB enrollment within the calendar year or spell. Note that QMB status may fluctuate for a minority of Beneficiaries. If the HETS response indicates the Beneficiary QMB enrollment has terminated, please verify the patient’s QMB status through State online Medicaid eligibility systems or other documentation, including Medicaid Identification cards and documents issued by the State proving the patient qualifies for the QMB program.
- QMB periods will only be returned in the 271 when the Beneficiary has the appropriate Medicare entitlement and the QMB enrollment intersects at least one of the following: • One day within a calendar year contained in the request date(s) or unique DOEBA year of any spell being returned • The DOEBA-DOLBA of any spell being returned • The current date
- QMB Periods in the 271 Will Result in Changes to Non-QMB Period 271 Financial Data. Financial data in the HETS 271 response will appear differently for non-QMB periods for Medicare Beneficiaries that have at least one QMB period intersecting the current date and/or the calendar (years) of the date/date range of the 270 request. As outlined in Section 3.3, QMB periods will be returned as separate entitlement periods with independent financial details. Non-QMB periods returned on the 271 response will be adjusted to illustrate that they are separate from a QMB period.
- Change to 271 Hospice Occurrence Count – HETS 271 responses will only include the Hospice Occurrence Count if the Medicare Beneficiary has Part A Entitlement. If the Medicare Beneficiary does not have Part A Entitlement, the Hospice Occurrence Count benefit will not be returned on the 271. All other normal Hospice Care period business rules apply.
- Change to 271 Hospital Spell Dates – HETS 271 responses will return the DOEBA and DOLBA dates of all hospital spells intersecting the current date and/or the calendar (years) of the date/date range of Centers for Medicare & Medicaid Services, Office of Technology Solutions HETS R2017Q400 Release Summary Document Version 1.05 5 the 270 request. This data will be returned in the HETS 271 response regardless and is not contingent on any specific Service Type Code (STC) or HCPCS code in the 270 request.
- Change to Part A/Part B Free Services – HETS 271 responses will return the Part A Free Services date(s) within a single 271 2110C loop EB segment with the potential for multiple DTP segments, regardless of what calendar year they fall within. Similarly, HETS 271 responses will return the Part B Free Services date(s) within a single 271 2110C loop EB segment with the potential for multiple DTP segments, regardless of what calendar year they fall within. Finally, both Part A and Part B Free Services will only be returned for non-QMB Periods.
The link below includes the full text from CMS.
Maintenance Monday November 13th Starting at 10:00 pm ET: MPV Real Time EligibilityNovember 9, 2017 1:20 pm
Last updated on November 13th, 2017 at 09:48 pm CT
[10:34 PM ET]
Maintenance has been completed. Real Time has returned to normal operations.
The Experian Health engineering team will be performing maintenance on Real Time Eligibility systems the night of Monday, November 13th beginning at 10:00 PM ET.
The Eligibility Portal will still be accessible and Batch operations will not be impacted during this maintenance window. Real Time services, including performing real-time searches in the portal, will be impacted. The maintenance window is expected to last 30 minutes:
Monday, November 13th from 10:00 PM until 10:30 PM ET
Updates or changes to this planned maintenance will be posted here.
Experian Health Client Support
Recent CMS NPI Changes – 11.01.2017November 1, 2017 10:40 am
Last updated on December 5th, 2017 at 04:53 pm CT
Recently, CMS deactivated a number of NPIs in their HETS eligibility system that do not link to an active Medicare PTAN (Provider Transaction Access Number). If you are receiving “Provider is ineligible for inquiries” (AAA 50) error messages, please contact the enrollment department of your Medicare administrative contractor (MAC) and check the following:
- Is your PTAN still active? Only NPIs attached to active PTANs are allowed to send eligibility transactions.
- Does your PTAN link to the NPI being sent in your inquiries?
- Does the information on your NPPES enrollment record match the information on your 855 enrollment record with the MAC? Please compare these records line by line. Any changes to your facility name, address, etc. can prevent CMS from being able to properly identify you.
All changes or updates to your NPIs and PTANs will need to be addressed by your MAC. Experian Health is unable to make adjustments to the information that CMS has on file.
Legacy MPV Eligibility Portal – Slow Responses Due to Very High Volume 11.01.2017 – ResolvedNovember 1, 2017 10:04 am
Last updated on November 4th, 2017 at 05:03 pm CT
[11.01.2017 11:50 a.m. CT]
Experian Engineering is still seeing very high volumes, but processing times have returned to normal.
They will continue to monitor throughout the day.
[11.01.2017 9:45 a.m. CT]
Experian Engineering is aware of and working on Eligibility Portal performance issues.
Resources being reviewed to manage extremely high begining of the month volumes.
We do not have an ETA for at this time.
CMS Medicare HETS 270/271 Scheduled Outage – Saturday, October 21-22, 2017October 18, 2017 11:16 am
Last updated on October 19th, 2017 at 12:34 pm CT
CMS Medicare HETS 270/271 Scheduled Outage – Saturday, October 21-22, 2017
CMS announced an upcoming outage to the Medicare HETS 270/271 eligibility system. CMS data center maintenance will begin at 11:30 PM ET on Saturday, October 21, 2017. The HETS 270/271 system will be unavailable during this period. Attempts to open a connection to the HETS 270/271 application will result in errors. CMS estimates that the maintenance window will be completed by 8:00 AM ET on Sunday, October 22, 2017.
MPV Eligibility Portal – Users unable to get beyond initial login page – Resolved 10.04.17October 4, 2017 7:46 am
Last updated on October 7th, 2017 at 02:22 pm CT
08:40 AM CT:
Experian Technical team has resolved this issue and a root cause is underinvestigation.
Portal operations and access have returned to normal operations.
08:20 AM CT:
Experian Technical team is continuting to work this issue as a critical priority.
They are making progress, but a firm ETA is not available at this time.
07:30 AM CT:
Experian Technical team is working on an issue that is not allowing users past the initial login screen.
This is being worked as a critical priority item.
We do not have an ETA for resolution at this time.
Humana Transaction Processing Issue – 09.26.2017September 26, 2017 10:48 am
Last updated on October 3rd, 2017 at 10:03 am CT
Humana is currently experiencing an issue that is impacting multiple transaction processing.
They are working on restoring services. We will inform you when the issue is resolved.
Welcome – To Experian Health’s New Product DashboardAugust 31, 2017 6:42 pm
Last updated on October 18th, 2017 at 11:55 am CT
Welcome to Experian Health’s New Product Dashboard
On August 31, 2017, we completed the transition to our new product dashboard.
We want to encourage you to visit our new product dashboard on your mobile device and invite other team members and colleagues within your organization to subscribe. Our new product dashboard has the same URL Address as before. http://www.experianhealthproductdashboard.com/
Subscribing is Easy
Just visit our product dashboard (link below) and choose “Subscribe.” Enter the email address where you want to receive your notifications. Subscribing to our product dashboard provides you with near real-time information about our products, important announcements, maintenance, and upcoming release notes.
After subscribing, please make sure you adjust any spam or junk email filters so that your email notifications will correctly go to the inbox of the email address that you enter. Post notifications will come from Experian Health Product Dashboard firstname.lastname@example.org
Hint: For our clients who are on-the-go and would like to receive their notifications via standard SMS/MMS text message, you can use the link below to enter your mobile telephone number and your mobile phone carrier’s gateway, as your Subscription. SMS/MMS notifications are only available if supported by your mobile phone carrier. Click Here to learn more about your mobile carrier’s email to SMS/MMS gateways to use as a Subscription to our dashboard notifications with your mobile device.
If you have any questions about the Experian Health Product Dashboard, please email our exceptional Customer Support team. email@example.com.