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Previous EDI Update Bulletins!

Labor Day holiday 

Our office will be closed on Monday, September 4, in observance of Labor Day. You can transmit claims and pick up messages whenever it’s convenient to you throughout the extended weekend. Transmission of claims to the payers, posting of new messages to your electronic mail box, and client support will resume on Tuesday, September 5.  

Payer changes

The following payers will be live, effective September 5. These payers will be added automatically to your 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 also included for your convenience.

New medical payer                 Payer number    Alias number

First Integrated Health                          ("  30537")       (75232)

Georgia Health Plan PPO                     ("  30538")      (58207)

Health One Alliance PPO                      ("  30539")      (58216)

Medplan PPO                                      ("  30540")      (58216)

Compfirst                                             ("  30541")      (23296)

Ohio Health Choice PPO                      ("  30542")      (34189)

Alexian Brothers                                    ("  30543")     (37117)

St Therese Physician Assoc                   ("  30544")      (37116)

Hinsdale Physicians Hlth                        ("  30545")      (37115)

Health Alliance Excl Plus                        ("  30546")      (23172)

Vantage Health Plan Inc                         ("  30547")     (72128)

Brown and Brown Benefits                    ("  30548")      (59069)

Cape Health Plan                                  ("  30549")       (38245)

Payer number deletions                   Payer number    Alias number

Opticare Eye Health Network                   (“  30428”)           (H0630)

WPS Champus                                         (“  73000”)            (H0019)

    Sunstar Health Plan Inc                            (“  30332”)            (H0497)

Payer number re-routing

Effective immediately claims for Sagamore Health Network oms_payno (“  31017”) Payalias (H0080) will be re-routed to Sagamore Health Networks oms_payno (“1979001”) Payalias (MUSSGMR).

REMINDER—Payer numbers re-routed now / deleted in October     

The following UnitedHealthcare payer numbers are being re-routed to one single Payer ID number—2009000. On October 4, these old Payer ID numbers will be deleted and the claims processing program will only recognize ID 2009000. To avoid rejections, update all of these payers in your system to the new ID before October.

United Healthcare Of Georgia          (“ 509100”)

PHP Of Sc                                (“ 509101”)

Western Ohio Healthcare Corp        (“ 509102”)

Ocean State PHP Fall River Ma       (“ 509104”)

UHC Of North Carolina                   (“ 509106”)

Share Hlthplan Of Illinois            (“ 509109”)

Share Hlthplan Of Il Capitated          (“ 509111”)

UHC Of The Midlands Inc Choice  (“ 509120”)

UHC Of The Midlands Inc Select    (“ 509121”)

PHP Of Ohio Clinicare               (“ 509122”)

PHP Of Ohio Benefit Systems          (“ 509123”)

Ocean State PHP Commercial        (“ 509126”)

Ocean State PHP Mcare Mcaid       (“ 509127”)

PHP Of St Louis                        (“ 509128”)

PHP Of St Louis Carus             (“ 509129”)

New York Hospitals Care Networ    (“ 509131”)

United Hlthcare Of Utah             (“ 509133”)

Metrahealth Admin For Met Life      (“ 509134”)

Metrahealth                                (“ 509135”)

United Healthcare Of Florida       (“ 509136”)

United Healthcare Of Mid Atlan              (“ 509137”)

United Healthcare Of The South       (“ 509138”)

United Healthcare Of Kentucky        (“ 509139”)

United Healthcare Of Colorado        (“ 509140”)

United Healthcare Of North Ca        (“ 509141”)

United Healthcare Of South Ca        (“ 509142”)

UHC Of  South  Florida            (“ 509143”)

UHC South Birmingham Al                (“ 509144”)

UHC South  Nashville Tn                 (“ 509145”)

UHC Louisiana                          (“ 509146”)

UHC South Jackson Ms                  (“ 509147”)

UHC South Little Rock Ar               (“ 509148”)

Evercare                                    (“ 509149”)

United Health And Life               (“ 509150”)

United Healthcare Of Arizona           (“ 509151”)

United Healthcare Of New York     (“ 509152”)

United Healthcare Upstate Ny          (“ 509153”)

UHC Health Plans Puerto Rico         (“ 509154”)

United Healthcare Of Texas             (“ 509155”)

United Healthcare Of Virginia           (“ 509156”)

Total Care Management                       (“ 509157”)

Changes to BCBS Virginia electronic remittance format

In mid December 2000, Trigon Blue Cross Blue Shield of Virginia (payno = 820000) will be making changes to their electronic remittance format. To ensure your system is ready to handle these changes by the deadline, Trigon will supply test files during October and November. You may request as many test files as needed. For further information, please contact Rick Touhey, Per-Se’s Payer Relations Manager, at 847-608-7000, ext. 104.

New ANSI reason code for provider remittance advice  

In an ongoing effort to improve the healthcare industry, particularly the Medicare program, the American National Standard Institute (ANSI) has developed standards for electronic claims transmissions that simplify the efficient trans-mission of certain health information. Effective September 1, 2000, a new ANSI code will be used to identify a claim with a provider-level late claim adjustment. When applicable, the Provider Remittance message will now state: “MA119 Provider level adjustment for late claim filing applies to this claim.     —from the August 2000 WPS Medicare B Bulletin

Medicare beneficiary statements being replaced

To simplify beneficiary notices, Medicare has redesigned its statements. In September, the new Medicare Summary Notice (MSN) will replace the Explanation of Medicare Part B Benefits (EOMB) statement, the Medicare Benefits Notice (Part A) and the benefit denial letters. This new monthly notice is easier to read, clearly listing all claims information. A few Medicare contractors will continue to send the current notices until they issue the new MSN at a later date. As always, but especially during the interim, CAREFULLY READ ALL MEDICARE NOTICES. Make sure that everything billed to Medicare is valid. Direct any questions to the carrier or to the intermediary listed on the front of the notice. Check out http://www.medicare.gov/basics/SummaryNotice_HowToReadB.asp for a sample MSN and instructions for reading it.                     —from WPS Medicare B Bulletin dated August 2000, and the Medicare web site

Kansas BC/BS Internet services 

In January 2001 contracting providers will be able to check the status of their Blue Shield claims (payno=”100000” and “100001”) via a secure site on the Internet at www.bcbsks.com. For initial validation, you will be required to use a logon ID and password. You will be supplied with the claim amount, amount paid, to whom it was paid, date, and provider/patient responsibilities.         —from the July 2000 Administrative Services of Kansas, Inc. July 2000 newsletter

Invalid insured identification numbers  

Many claims for Aetna US Healthcare (payer ID 30135) are coming across with invalid INSURED’S IDENTIFICATION NUMBERS. These claims ultimately error at the payer. Following are five examples of how the Insured identification number (box 1a on the HCFA 1500 claims form) should correctly be submitted.

IMPORTANT NOTICE

Concerning Anesthesia Claims for PAYNO “ 10000”, “ 180000”, and “ 640000”

1. Submit total time in minutes

Beginning October 1, 2000, submit total time in minutes (rather than units) on all anesthesia claims! This change reflects Anthem Blue Cross Blue Shield’s efforts to make filing claims easier and more standardized with Medicare and other commercial carriers. Anthem systems will not be set up to automatically calculate minute conversions until October 1, 2000, so please continue to file anesthesia claims in the usual fashion until then:

4 If  you are currently sending anesthesia units on your electronic claims to Per-Se, you can continue to do so after October 1 and we will make sure that what gets through to Anthem is the minutes.

4 If you are currently sending the total time in minutes, please continue to do so.

Beginning October 1, 2000, anesthesia claims should be processed as follows:

4With the applicable surgical CPT-4 or ASA code (if only the ASA is filed, sometimes it is requested that the CTP-4 code is given).

4Anthem products, Blue Access and Blue Preferred, and all Blue Card (ITS) claims MUST be filed with a surgical CPT-4 (ASA codes are accepted for epidural anesthesia related labor and delivery).

4With actual time, IN MINUTES (For example, one hour and 40 minutes would be reported as 100 minutes).

4With applicable Physical Status Modifiers

Remember: When filing anesthesia claims, the service minutes are REQUIRED in order for the claims to process correctly. If you are unclear about where you should be supplying your minute’s value, please contact our support staff.

2. Entering physical status modifiers

If filling electronically, enter the physical status modifier in field FA0-10 for NSF.

If filing on paper, on the HCFA 1500, enter the physical status modifiers in Block 24D (modifier).

Uniprise (UnitedHealthcare) replacement contractors

Uniprise announced on 02/10/2000 that it was withdrawing as a Medicare A, B, and Durable Medical Equipment (DMERC) contractor. Uniprise currently processes Medicare Part B claim for Connecticut, Minnesota, Mississippi and Virginia. They also provide administration to railroad retirees through a contract with the Railroad Retirement Board.

1. Replacement contractors

The contractors replacing UnitedHealthcare (UHC), beginning at the end of September 2000, are as follows:

4Connecticut Medicare Part B contract—First Coast Service Options (FCSO)

4Minnesota Medicare Part B contract—Wisconsin Physician Services (WPS)

4Mississippi Medicare Part B contract—Cahaba Government Benefits Administrators

    (a division of Blue Cross Blue Shield of Alabama)

4Virginia Medicare Part B contract—TrailBlazers Health Enterprises (THE)

4Railroad Medicare Part B contract—Palmetto Government Benefits Administrators LLC

    (a subsidiary of Blue Cross and Blue Shield of South Carolina)

2. Migration schedule

     Following is the schedule for migration from UHC to new Medicare B contractors: