A couple of interesting acquisitions in healthcare land. It was announced today that Experian (yes credit reporting Experian) is aquiring Passport Health Communications for alot of money.
Experian to buy Passport Health Communications for $850 Million.
This was announced a while ago but it’s still interesting. CHS is buying HMA. Once this deal has closed, they will have a total of 209 hospitals nationwide.
Community Health Systems to buy HMA
Over the next few weeks you’ll notice format changes on the prefix pages. The way the tables are loaded currently, adding additional prefixes is somewhat of a nightmare. I’m going to be converting those pages into a different style of table so they’ll be easier to update. Also I’m looking for someone to help me update them monthly so you’ll see more frequent changes/additions.
If there are prefixes you would like to have added, please send them through Contact Us (it’s in the footer).
I can’t believe it’s already October 1st. Health insurance exchanges will go into effect today and I’m curious how this will effect your business. If you have a few minutes I would love to get your feedback on these questions.
1. Did you get any training on insurance exchanges?
2. How is your office/facility preparing for patient’s enrolled in HIEs?
Aetna just out a message about a problem with members that have a foreign address. I thought I would pass it on.
“Our Eligibility and Benefits Inquiry transaction can’t return eligibility responses when the member has a foreign address. Providers will see one of the following responses:
• An incomplete response, where the state, postal code and country code fields are blank, or
• A “Required application data missing” error message
Transactions submitted with an inquiry date of 1/1/2013 or later will return the AAA15 error message.
As a workaround, providers who are unable to get a complete response for foreign members can call Aetna’s Provider Service Centers at 1-888-MD-AETNA (1-888-632-3862) for complete eligibility information.”
Many of you have probably already received this from Aetna but I thought I would still pass it on. Aetna had a release last week and fixed some long standing bugs. Below is an exerpt of the announcement they sent out regarding the release.
Eligibility Transaction Changes
1. We’ll remove the following messages, which are no longer needed:
o The “Age Limit Applies” message is no longer needed, as we give the actual ages in our response when limits apply.
o The “Applies to HMO provider” message is not needed, as we no longer have a need to limit benefits specifically for HMO providers.
2. In support of Safe Harbor guidelines, which provides contraceptive supplemental coverage through a separate plan with Aetna listed as the plan sponsor, we’ll:
o Issue two Member ID cards, one for the base medical plan and one for the supplemental contraceptive coverage plan.
o Return a message within the eligibility transaction to direct providers to the appropriate plan when necessary to obtain benefits.
3. We’ll add a message when some Not Covered responses are returned.
Benefits may be available. Please inquire under member’s medical plan
Please inquire under member’s medical plan
Member does not fall within the age limitations for this benefit
A few interesting tid bits this week.
- CHS (Community Health System) announced they’re going to buy HMA (Health Management Associates) for $3.6 Billion. CHS would have a total of 206 hospitals if this deal goes through.
- Effective 8/1, Oregon Medicaid removed the managed care assignment information from the eligibility response. Members that are assigned to Heath Share in Oregon will need to contact them directly to verify if the member has Kaiser, CareOregon, etc. From what I can tell, none of the eligibility vendors have HealthShare data yet so it will either be another phone call or you will have to log into their portal.
- United Health Community Care electronic eligibility responses are returning bad ID numbers for members in Ohio and New Jersey. UHC is investigating but they aren’t known for their speed. Make sure you double check the ID number against their new cards before you change anything in your registration system.
North Carolina Medicaid Conversion
North Carolina officially switched from Xerox to CSC last night and so far eligibility transactions are running smoothly. Last week CSC changed the enrollment requirement for eligibility transactions after getting barraged with complaints. I’m happy to say that this is one of the smoothest fiscal agent transitions I’ve seen. If anyone has any feedback on CSC’s support, please let me know.
If you run into any issues, the NC Tracks support line is 1-800-688-6696.
Tricare DOD ID Numbers
By now most of you are seeing the new Tricare cards with the DoD number instead of the sponsors SSN. There are two numbers on the card. Be sure that you are using the 11 digit ID number on the back of the card for claim submission. You can not use the 10 digit ID number on the front of the card for checking eligibility electronically or for submitting claims.
CMS will be making some changes to the Medicare realtime eligibility response next weekend. This does not effect DDE responses (HIQA, HIQH,etc).
1. The Medicare preventive data will be removed from the response. It will only be returned if a HCPCS code is specifically requested. So if you’re trying to find out if the beneficiary is eligible for a mammogram, you will need to request one of the mammography HCPCS codes. They will also be showing more detailed financial info on each service including whether or not the deductible and/or coinsurance is waived for that service. I’ve include the screening tests below with the appropriate codes.
2. The response will now show the individual hospice periods instead of lumping them into one large period. You will be able to see the beginning and ending date for each period.
North Carolina Medicaid will be switching to their new claims system, NCtracks, effective 7/1. There’s a pretty lengthy checklist of things that need to be completed by the conversion, which I have included below along with the registration application. I’m going to assume most of you have already done this so this really only applies to the procrastinators.
There are rumors floating around that the new fiscal agent, CSC, won’t be ready to provide realtime eligibility come 7/1. Also in order to get eligibility through your current vendor, you will need to log into the NC Tracks web portal and designate your vendors. You will have to do this for both your claims clearinghouse and your eligibility vendor. Unfortunately you can only choose one vendor until July. For more information, there is a special website setup for NCTracks or you can sign up for their email list.
Provider Checklist for NCTracks Go-Live
The purpose of this checklist is to help DHHS providers understand the tasks they need to perform, and how and when to do them, to enable a smooth transition to the new NCTracks system.
- Designate the Billing Agent for your provider organization. (Applies to providers who use a Billing Agent/Clearinghouse.)
- Obtain an NCID for your Office Administrator (owner/managing employee)
- Obtain an NCID for all other staff in your provider organization who will access the NCTracks system and who will be trained
- Update your affiliation information. (Applies to individual providers who are in groups and/or affiliated with hospitals, etc.) Submit a Medicaid Provider Change Form on the current NCTracks site at www.nctracks.nc.gov
- Designate the Office Administrator (OA) for your provider organization (using NCID)
- Provide your bank account information for EFT payments
- Make sure your OA email address is current in the system
- Electronically sign the Trading Partner Agreement. (Applies to Billing Agents and providers who will submit ASC X12 batch transactions to NCTracks.)
- Complete the recommended NCTracks on-line training. (Must have a NCID)
- Verify the taxonomy codes and locations on your provider record.
Aetna announced yesterday that they’ve completed the purchase of Coventry Health Care. I’m sure it will take them years to integrate the Coventry plans to Aetna claims and eligibility systems but I bet the new cards will start showing up before the end of the year.
UHC moved Unison/Coventry of Ohio to payer code 87726 last week. The new cards with new ID numbers have been issued so make sure to ask patients for their new card. From what I can tell, 87726 won’t accept the old ID numbers for eligibility transactions but I’m not sure what that means for claim submission. I’m trying to get a good answer from UHC on why the old ID numbers aren’t working.