CollaborateMD Blog

Eligibility: CMS Medicare – Payer Scheduled Maintenance

Thu, 23 Feb 2012 15:06:49 -0500

CollaborateMD has been notified that CMS MEDICARE has scheduled maintenance on Sunday, 02/26/2012 from 6:00 AM CT to 12:00 PM CT. During this time eligibility transactions should not be sent. Requests sent during the scheduled maintenance time may receive a response stating Unable to Respond at Current Time.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Eligibility: Florida Blue Cross Blue Shield – Payer Scheduled Maintenance

Thu, 23 Feb 2012 15:04:57 -0500

CollaborateMD has been notified that FLORIDA BLUE CROSS BLUE SHIELD has scheduled maintenance on Saturday, 02/25/2012 from 8:00 PM CT to Monday, 02/27/2012 at 5:00 AM CT. During these times eligibility transactions should not be sent. Requests sent during the scheduled maintenance time may receive a response stating Unable to Respond at Current Time. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims: Multiple CPIDs: 5010 Claims Processing Delays/Issues

Thu, 23 Feb 2012 15:00:16 -0500

These payers are having processing issues affecting Professional and Institutional 5010 claims processing and report generation.Payers affected are: CPID 1443 Retired Railroad MedicareCPID 1444 Southern California MedicareCPID 1450 West Virginia MedicareCPID 1464 North Carolina MedicareCPID 1560 South Carolina MedicareCPID 2462 Kentucky MedicareCPID 3507 Ohio MedicareCPID 5533 Kentucky MedicareCPID 5556 Mississippi MedicareThese issues and delays occurred from February 20, 2012 to present, and are due to a payer processing issue.The clearinghouse is working diligently with the payer to resolve these issues and to ensure all claims are processed. Further notification will be provided as additional information becomes available. We apologize for any inconvenience.Please be aware of this payer processing delay.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims: Multiple CPIDs: Noridian Administrative Services Changes Medicare Payer IDs

Wed, 22 Feb 2012 14:42:31 -0500

Effective 02/25/2012, Noridian Administrative Services will change the following payer IDs in Medicare A and B Jurisdiction:The Medicare Part A Payer IDs will change to 02001 for:CPID 5521 Alaska Medicare - current payer ID 00322 or 00326CPID 5581 Idaho Medicare - current payer ID 00325 or 00326CPID 5515 Oregon Medicare - current payer ID 00325 or 00326CPID 5521 Washington Medicare - current payer ID 00322 or 00326The Medicare Part B Payer IDs will change as follows:CPID 1455 Alaska Medicare - current payer ID 00831 will change to 02102 CPID 1459 Oregon Medicare - current payer ID 00835 will change to 02302CPID 1462 Washington Medicare - current payer ID 00836 will change to 02402The clearinghouse will convert the Payer ID sent within the claim file to the new Payer ID. Claims sent to Noridian as of 02/25/2012 will contain the new Payer IDs.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims Multiple CPIDs: New Payer Edit

Mon, 20 Feb 2012 14:52:56 -0500

Multiple payers have informed the clearinghouse of a new edit requirement effective immediately. In order to meet the new requirement, the clearinghouse has added the below edit on February 20, 2012 for the following payers:Edit ZZ IHI-0151: INVALID VALUE AMOUNT - When the Value Code 45 is present the Value Amount must be a valid hour 0-23 or 99. Leading zeros are not allowed.Payers affected are:CPID 1930 AmeriHealth New Jersey/Delaware - HMOCPID 3557 Pennsylvania Independence AmeriHealth HMOCPID 3558 Pennsylvania Independence AmeriHealth PPOCPID 3559 Pennsylvania Independence Keystone Health Plan EastPlease be aware of updated edit requirements.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims: Common 5010 Claim Rejections: Payer 5010 Claim Rejections by Health Care Services Corporation

Mon, 20 Feb 2012 14:44:25 -0500

A large number of 5010 claims are being rejected by payers when providers include:- Incorrect Provider NPIs in the billing and rendering physician fields- A Tax Identification Number that is not linked to their Provider NPI As a reminder, per 5010 claim requirements, the Provider NPI for the rendering physician may not be the same as for billing physician. If incorrect information is entered for this field, the Tax ID is used for alternate identification. Thus, correct information is required in both fields.While these types of rejections could happen with any payer, the clearinghouse identified this problem with Health Care Services Corporation (HCSC) and let them know we have been seeing a spike in these rejections since February 7, 2012. If you receive a payer claim rejection of this type, HCSC recommends you contact them directly at 800-746-4614 to verify the correct provider information to be included on these claims.CPIDs impacted:CPID 1405 Illinois Blue Shield CPID 5508 Illinois Blue CrossCPID 7403 Oklahoma Blue Shield CPID 1514 Oklahoma Blue Cross CPID 1403 New Mexico Blue Shield CPID 5565 New Mexico Blue Cross CPID 1406 Texas Blue Shield CPID 5501 Texas Blue CrossEnsure that the correct provider NPI and Tax ID are being input for 5010 claims. For payer claim rejections due to this issue, contact HCSC to determine the correct NPI to be reported so that the claims will get processed.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims: Multiple CPIDs: New Payer Edit

Mon, 20 Feb 2012 13:55:22 -0500

Multiple payers have informed the clearinghouse of a new edit requirement effective immediately. In order to meet the new requirement, the clearinghouse has added the below edit on February 15, 2012 for the following payers:Edit ZZ IHI-0151: INVALID VALUE AMOUNT - When the Value Code 45 is present the Value Amount must be a valid hour 0-23 or 99. Leading zeros are not allowed.Payers affected are:CPID 8503 Tricare North RegionCPID 6594 Tricare South RegionCPID 1559 South Carolina Blue CrossCPID 3560 Pennsylvania Independence Blue CrossPlease be aware of updated edit requirements.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims: CPIDs 4456, 8503, 6594 Tricare North and South Regions: Tricare Claims Processing Delays / Issues

Mon, 20 Feb 2012 13:52:27 -0500

The clearinghouse has identified processing delays affecting Professional and Institutional claims processing and report generation for Tricare North and South Regions (CPIDs 4456, 8503, and 6594). These delays are due to a payer processing issue. These delays from Tricare occurred from January 01, 2012 to present. The clearinghouse is working diligently with the payer to resolve these issues and to ensure all claims are processed. We apologize for any inconvenience. If you have any questions, please contact Client Servies at 1-888-348-8457, option 2.

Claims: Multiple CPIDs: Payor Intermediary Processing Issue Related to 5010 Claims Processing

Mon, 20 Feb 2012 13:48:48 -0500

From December 12, 2011 to February 9, 2012, a payer intermediary was experiencing issues related to 5010 claims processing, including:Dropping Present on Admission (POA) values Y (diagnosis was present) N (diagnosis was not present), U (documentation insufficient) and W (clinically undetermined) from claims.Problems successfully upconverting provider 4010 claims for payers only accepting 5010 claims.Processing incoming 5010 claims and delivering them to payers in 5010 format.These processing issues are impacting the following payers:CPID 6531 Keystone Mercy Health PlanCPID 1569 Amerigroup CorporationCPID 1973 HealthFirst of New YorkCPID 7501 Neighborhood Health ProvidersTo ensure your claims get accepted on first pass, effective February 9, 2012, the clearinghouse began sending only 5010 claims to these payers - either pure 5010 or reformatted 4010 claims. Action Required: Resubmit any impacted claims as soon as possible.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims: Multiple CPIDs: 5010 Noridian Medicare A and B Processing Delays

Mon, 20 Feb 2012 13:44:20 -0500

From February 14, 2011 at 12:00 PM to present, Noridian has experienced 5010 claims processing delays associated with:Receipt of claims to their datacenter.Generation of 277CA reports for all Medicare Trading Partners. The reports may take up to 43 hours to generate.The following payers are affected:CPID 1455 Alaska MedicareCPID 1456 Arizona MedicareCPID 5546 Arizona MedicareCPID 5581 Idaho MedicareCPID 3521 Minnesota MedicareCPID 5584 Montana MedicareCPID 7400 Montana MedicareCPID 1523 North Dakota MedicareCPID 2453 North Dakota MedicareCPID 1459 Oregon MedicareCPID 5515 Oregon MedicareCPID 2454 South Dakota MedicareCPID 5589 South Dakota MedicareCPID 1527 Utah MedicareCPID 2458 Utah MedicareCPID 1462 Washington MedicareCPID 5521 Washington and Alaska MedicareCPID 2466 Wyoming MedicareCPID 3583 Wyoming MedicarePlease be aware of these processing delays.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Eligibility: Multiple Payers – Payer Scheduled Maintenance

Fri, 17 Feb 2012 15:17:19 -0500

CollaborateMD has been notified the following payers have scheduled maintenance on Saturday, 02/18/2012 from 4:00 PM to 10:00 PM CT. During these times eligibility transactions should not be sent. Requests sent during the scheduled maintenance time may receive a response stating Unable to Respond at Current Time. HumanaIllinois Blue Cross Blue ShieldMinnesota Blue Cross Blue ShieldNew Mexico Blue Cross Blue ShieldTexas Blue Cross Blue ShieldWashington Regence Blue Cross Blue ShieldIf you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Eligibility: Anthem / Wellpoint – Payer Processing Issue Resolved

Thu, 16 Feb 2012 13:33:46 -0500

CollaborateMD has been notified that ANTHEM / WELLPOINT has resolved their processing issues and can now receive eligibility transactions. You may resume sending eligibility transactions to these payers.California Blue CrossColorado Blue Cross Blue ShieldConnecticut Blue Cross Blue ShieldGeorgia Blue Cross Blue ShieldIndiana Blue Cross Blue ShieldKentucky Blue Cross Blue ShieldMaine Blue Cross Blue ShieldMissouri Blue Cross Blue ShieldNevada Blue Cross Blue ShieldNew Hampshire Blue Cross Blue ShieldOhio Blue Cross Blue ShieldTexas Blue Cross Blue ShieldVirginia Blue Cross Blue ShieldWisconsin Blue Cross Blue ShieldUnicareIf you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Eligibility: Anthem / Wellpoint – Payer Processing Issue

Thu, 16 Feb 2012 11:52:56 -0500

CollaborateMD has been notified that ANTHEM / WELLPOINT payers are returning Invalid/Missing Provider Identification. The payers are working to resolve this issue as soon as possible.California Blue CrossColorado Blue Cross Blue ShieldConnecticut Blue Cross Blue ShieldGeorgia Blue Cross Blue ShieldIndiana Blue Cross Blue ShieldKentucky Blue Cross Blue ShieldMaine Blue Cross Blue ShieldMissouri Blue Cross Blue ShieldNevada Blue Cross Blue ShieldNew Hampshire Blue Cross Blue ShieldOhio Blue Cross Blue ShieldTexas Blue Cross Blue ShieldVirginia Blue Cross Blue ShieldWisconsin Blue Cross Blue ShieldUnicareIf you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Claims: CPID 4749 Tricare for Life: Generates Invalid Edit Reject Code Due to Payer Processing Issue

Wed, 15 Feb 2012 13:33:48 -0500

Due to a payer processing issue, standardized payer reports for TriCare for Life (CPID 4749) may have included an invalid rejection message on the Payer Report Data File (SF) and the Payer Claim Data Report (SR). This issue began on January 14, 2012 and is ongoing.Payers affected are:CPID 4749 TriCare for Life The message states, Reject Code: A3:21, MISSING OR INVALID INFORMATION. Claims with this reject code that have received an associated payer Internal Control Number (ICN) have been processed. (The ICN number is returned in the REF segment with a 1K qualifier within the Payer Report Data File (SF). Claims with this reject code that did not receive an associated payer Internal Control Number (ICN) have been rejected by the payer. Please correct and resubmit these claims. The clearinghouse is working with this payer to resolve this issue.Action Required: Please correct and resubmit claims that do not have an ICN number and have been rejected.If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

Eligibility: Healthfirst of New York – Payer Processing Issue

Wed, 15 Feb 2012 13:26:38 -0500

CollaborateMD has identified that HEALTHFIRST OF NEW YORK is temporarily unable to process eligibility transactions. The payer is aware of the issue and is working to restore service as quickly as possible. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.