Passport Medical Necessity
Experian Health – Voice Your Concern to CMS About New MBIs – 04.04.2018April 4, 2018 12:41 pm
Last updated on April 7th, 2018 at 12:41 pm CT
Regarding the New Medicare Beneficiary Identification Project, Experian Health is providing you the opportunity to voice your concerns and send the attached recommended MBI Enhancement Request to CMS.
As we are all aware, the Medicare Beneficiary ID will be changing beginning in April 2018. While all of us advocate for Electronic Data Interchange standardization and compliance within the healthcare industry, there are some issues of which those who use Medicare’s eligibility system (HETS 270/271) should be aware. The current decision from CMS is that the MBI will be returned only on the eligibility response (271) if the MBI is used in the inquiry (270). CMS will require a provider to use a look up tool available through the individual MAC’s website when a provider cannot obtain the new MBI from the member. Additionally, CMS will be returning the MBI in the E1 NCPDP transaction (the pharmacy equivalent to the 270/271 transaction) if the HICN is submitted. Due to the complications this change will make to a provider’s workflow when registering a Medicare Beneficiary, we as an part of a larger EDI community have drafted a recommended enhancement request to CMS.
Please read the two links below that include a cover letter and instructions for the steps to follow to complete the attached template for the enhancement request to send to CMS. Experian Health has also sent this request to CMS.
(Previous Post - Reference) Last and Previous Posts: March 29, 2018 - Deadline Approaching – New Medicare Beneficiary Identifier (MBI) – Update Last and Previous Posts: March 22, 2018 - Reminder – New Medicare Beneficiary Identifier (MBI), April 2018 – Update Last and Previous Posts: March 9, 2018 - New Medicare Beneficiary Identifier (MBI), April 2018 – Update
[March 29, 2018]
April 2018 – New Medicare Beneficiary Identifier (MBI) – Update, 03.29.2018
The April, 2018 has arrived. Please click this headline and review the information posted on our product dashboard under the New Medicare Beneficiary Identifier (MBI) April 2018. Experian Health is ready to accept both the HICN and MBI in the X12 270/271 Transactions (Eligibility Inquiry/Eligibility Response). A new “My Response” coverage banner will also be added to within OneSource and eCareNEXT, Within the returned 271 Eligibility Response, we will return the message segment:
“CMS mailed a Medicare Card with a new Medicare Beneficiary Identifier (MBI) to the Member”
For Premium EDI clients, we have created an Epic EDI alert that will return the same message. (Similar to when a patient has limited coverage, or a Medicare Advantage/Medicaid MCO.)
Please Note: CMS will only return that message for beneficiaries that have traditional Medicare. If they’re enrolled in a Medicare Advantage plan, Medicare will not return this information.
Intermittent OrderChecker Login Errors – 3.16.18March 16, 2018 4:19 pm
Last updated on March 27th, 2018 at 12:27 pm CT
[4:10pm CST] We are receiving intermittent reports from OrderChecker clients that they are unable to login to the application. Users are receiving a message stating, “Unable to Retrieve Config – Could not establish trust relationship for the SSL/TLS secure channel with authority ‘hworks.info’.” The systems development team is currently researching the issue. We will provide updates on the dashboard as they become available. We apologize for the inconvenience.
Scheduled Downtime – Scheduling, Orders, MedNec, and Authorizations – 02.08.2018February 8, 2018 11:34 am
Last updated on February 8th, 2018 at 12:47 pm CT
Scheduling, Orders, MedNec, and Authorizations – Thursday, February 8, 2018
On Thursday, February 8, 2018 we will perform hardware and maintenance updates for STAT Scheduling services, including OrderManager, Medical Necessity and Authorizations products.
- The STAT Schedule Manager interface will be unavailable between
7:00p.m. CT until 1:00a.m. CT (February 9).
- The OrderManager interface will be unavailable between 10:00p.m. CT – 11:00p.m.
- Both Medical Necessity and Authorizations products will be unavailable between
10:00p.m. CT – 1:00a.m. CT. (February 9).
Notice – Jurisdiction J Transitions, Cahaba to Palmetto – Effective Jan. 29, and Feb. 26, 2018November 15, 2017 2:21 pm
Last updated on March 1st, 2018 at 12:51 pm CT
TRANSITION FROM CAHABA TO PALMETTO
On September 7, 2017, the Centers for Medicare & Medicaid Services (CMS) announced that Palmetto GBA will begin transition of the new A/B Medicare Administrative Contract (A/B MAC) for Jurisdiction J (JJ), which includes Alabama, Georgia and Tennessee.
Below are the effective dates of the transition, along with the newly assigned contractor codes.
Part A – Effective 1/29/2018
Georgia Part A – Contractor code 10211
Tennessee Part A – Contractor code 10311
Part B – Effective 2/26/2018
Georgia Part B – Contractor number 10212
Tennessee Part B – Contractor number 10312
Regardless of the date of service, all claims processing, customer service and payments will be handled by Palmetto GBA JJ MAC upon the listed effective dates. Cahaba GBA will transfer all pending and in-process operations to Palmetto GBA JJ MAC at that time, including claims, appeals and enrollment applications.
A new Electronic Funds Transfer (EFT) agreement will NOT be required as your existing agreement will be transferred to Palmetto GBA. You will not need to take further action and your current EFT will remain in effect.
Experian Health providers currently submitting claims to Cahaba GBA will not be required to re-enroll or complete a new provider enrollment application with Palmetto GBA.
No payer code changes are required. Experian Health providers should continue to submit their claims using the following payer codes:
- Georgia Medicare Part A: 12M05
- Georgia Medicare Part B: SMGA0
- Tennessee Medicare Part A: 12M53
- Tennessee Medicare Part B: SMTN0