CMS recently released an update to the announcment that the CWF eligibility transactions will be sunset in 2014. The target date is April 7th to discontinue HIQA, HUQA, HIQH, ELGA, and ELGH. If you haven’t switched to using HETS either directly from Medicare or through a vendor, it’s definitely time to start looking for an alternative.
CMS announcement regarding the demise of the CWF:
It seems like I can’t open my email without seeing something about the Affordable Care Act and how it’s going to affect checking patient eligibility. We really hoped that the larger payers that were going to participate as healthcare exchange plans would be on top of things but that hasn’t been the reality.
What we’ve seen so far :
1. Some health plans did not have ACA members loaded as timely as we had hoped. Some are loading the bare minimum with the intentions of loading benefits later.
2. ACA members aren’t being clearly identified in the EDI eligibility responses by some insurance companies.
3. We still aren’t getting a clear picture of how the 90 day grace period is going to be represented in eligibility responses. A couple of payers have implemented very clear messages indicating that the person is within their 90 period but most have not.
The good news is that most payers are still making changes to accomodate the ACA membershship and we expect to see some improvements in February and March. I’ve already seen notifications from at least two large plans that they will be making changes in February to help clarify where the member is in relation to their grace period. I’ll post these changes as I get them.
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.