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Previous EDI Update Bulletins!
Managed Data Systems
EDI Update Bulletin!
|Vol. 3 No. 2||
February 2001 Edition
following payers now accept electronic claims. (For specific payer
edits, changes, and enhancements, see the global Per-Se Chicago EDIT
RELEASE NOTES, issued on 01/05/01 in software version 3.94.66.)
medical payers last month
MUTUAL HEALTH INS
HOSPITAL WATERMAN EMPL
BENEFIT ADMIN IL
INSURED PLANS LLC
BARNABAS SYSTEM HEALTH
hospital payers last month
NY HOS HLTH NYHCHP
AND BROWN BENEFIT HOS
MUTUAL HLTH HOS
HOSPITAL WATERMAN EMPL
BENEFIT SVCS MI HOS
PLANS INC HOS
INSURANCE CO HOS
HLTH PLN OF MI HOS
BENEFIT ADMIN IA HOS
FUNDED PLANS HOS
INSURED PLANS LLC HOS
BARNABAS SYSTEM HLTH HOS
OPTION ONE HOS
ERA payers last month
Future releases are
scheduled as follows:
fees increase On
01/02/01 all print-to-mail fees
increased by one cent. This increase, which applies to paper HCFA-1500
claims, paper UB-92 claims, and first-page patient/client statements, is
reflected on your current invoice.
and Healthsource NC rebates are
no longer applied to invoices due to changes in our contractual
agreements with the payers.
following changes are effective
New payers listed will be added automatically to your Per-Se payer
database. Be sure to match the
spelling of each payer with those produced in your billing system. If
you scan on the payer number instead of the payer name, those numbers are
BENEFIT MGMT EBMS
CARE SVCS HOS
OF NC HOS
GROUP ADMIN HOS
EDI claim level rejection edits
IDs 1371001, 1371002, 241001 and
PA/NJ has announced that effective with claims sub-mitted after 4:00 p.m.
on February 16, 2001, a claim level rejection will occur:
when procedure code Q0188 (echo-cardiography contrast agents) is
reported without the corresponding referring/ordering physician name and
UPIN number information.
on all assigned physical and occupational therapy claims if the
date last seen is not reported. If you transmit a print image file to
Per-Se, the date last seen should be supplied in Box 15. If you transmit
your claims to Per-Se in an (H)NSF, or NSF 2.0 or 3.0 format, the date
last seen should be supplied in EA0 record Position 267.
when the 2nd through 5th positions of the
procedure code is missing or non-numeric.
Cross Blue Shield Michigan
ID = 630000 and 630001)
following information was taken verbatim from the BCBSMI EDI Newsletter.
Because we have not sent these types of claims previously, please contact
our customer support department for testing purposes.
of 12/01/2000, all freestanding facilities (Physical Therapy, ESRD/Hemodialysis,
Skilled Nursing, Substance Abuse and Hospice) can submit most claims
electronically to Blue Cross Blue Shield of Michigan. The following claim
types are excluded at this time for these freestanding facilities:
Supplemental Substance Abuse claims
Bulletin on Medicare B data (Payer ID
The Balanced Budget Act (BBA) of 1997 required the Health Care Financing Administration (HCFA) to establish a risk adjustment payment methodology for Medicare+Choice Organizations (M+COs). As part of this process, M+COs (such as Humana) must collect and submit to HCFA claim/encounter data on all Medicare Part B physician services beginning with date of service 10/1/2000.
This notification does not change the manner in which data is submitted, but requests additional elements be submitted on each claim/encounter. Humana's request for additional data is consistent with Medicare's fee-for-service coding guidelines. Providers should continue to submit to Humana claim/encounter data using the HCFA 1500 Form or the HCFA 1500 National Standard Format (NSF) record (if submitting electronically). Providers participating in Humana's commercial plans may also submit claim/encounter data using the HCFA's 1500 or NSF record.
For additional information regarding these federal requirements, please see HCFA's website, www.hcfa.gov.
following mapping guide provides specific field requirement explanations
and the location in the Halley NSF record layout.
that Humana Health Plans accepts professional/medical claims through the
Per-Se Exchange using Payer ID 1359000.
If you have any questions regarding this bulletin, please contact
the Per-Se Exchange Support Department at (847) 608-7000.
requires the following information be submitted:
The Humana assigned
wants the following information on specialist claims.
This in not a required field, but will help facilitate claims
Authorization number for
requires the following information also be submitted on Medicare members:
Medicare Provider ID
for Home Health or Hospice.