Here are a few interesting goodies I’ve run across the past week or two. Have a great day!
I ran across a few interesting tidbits this week that I thought I would share.
I didn’t know that Aetna was moving to digital ID cards this quickly. Have any of you received any of these digital cards? If so is it causing you to change your workflow at all?
They posted this blurb in their provider bulletin this month:
If an Aetna patient shows you a digital or printed copy of their ID card, you should accept it. Old member ID cards could cost you and your patients’ time and money. We’ve got you covered. When you reference a digital ID the information is up to date. That’s why we’ve given you and our members the ability to access digital member IDs.
If a member doesn’t have a copy of their ID card, you should submit an eligibility and benefits inquiry using their name and date of birth. You should complete an eligibility and benefits inquiry for every patient at every visit. You’ll get a response with everything you need to know about your patient.
Learn more Check out our new reference tool and tutorial.
Change Healthcare (formerly Emdeon) has posted this notice numerous times and I thought it was worth passing along.
The Dept of Veterans Affairs (VA) has observed a high volume of EDI transactions rejected due to invalid member ids. The Department of Veterans Affairs (VA) would like to remind providers that new Veteran Health Identification Cards were issued to every veteran enrolled in VA health care, which includes the Veterans Choice Program. Each member ID card contains a new Member Identification (ID) Number and Plan ID. The veteran’s Social Security number (SSN) is no longer printed on health identification cards. Please also note that all inquiries for a veteran should be sent to payer ID for VAFEE and only spouses and dependents of Veterans should be sent to VAHAC or the member eligibility will not be found.
At the present time, providers must continue to use the Veteran’s SSN as the member ID when submitting EDI transactions to VA Fee Basis Programs. Per the payer’s instructions, Emdeon will reject EDI transactions that do not contain the veteran’s SSN as the member id. Providers should also ignore the Plan ID number printed on ID cards and continue to submit real-time transactions to Emdeon Payer ID VAFEE or 00231 for VA Fee Basis Program.
In the future, providers will be able to use the new veterans’ member ids when submitting EDI transactions, but an ETA has not yet been provided. The payer will provide more information on this matter as it becomes available and will publish updates on the VA ListServ Community Newsletter and Purchased Care website. http://www.va.gov/PURCHASEDCARE/programs/veterans/nonvacare/index.asp
The new cards have a 10 digit ID instead of the SSN so make sure you ask for the SSN when seeing these patients.
UHC has officially announced that their getting rid of their ACA business in all but 4 markets next year. I haven’t see the list of the states that will remain but I’ll post it when it’s released. It will be interesting to see who follows in their foot steps.
This might be a power move by BCBS to move the contract negotiations along. Dropping 44 HCA hospitals would be a huge deal.
This update from Aetna regarding their new consumer plans came across my desk this week. I think this is the first major payer I’ve seen that won’t be issuing paper/plastic cards.
On January 1, 2016, we’ll be launching new individual consumer plans in four markets. They are called Aetna LeapSM or Innovation Health LeapSM plans.
The counties/cities these plans are available in are:
As of January 1, we expect to have approximately 150,000 members enrolled in these new consumer Leap plans.
Important Leap Plan Information
I hope everyone had a wonderful Thanksgiving. I wanted to share a few interesting tidbits that crossed my desk this week.
Anthem changes the names of some of their Medicare Advantage Plans. Click the states to see the announcements
CMS sent out a press release regarding the 2016 Medicare premiums and deductibles yesterday. I didn’t see any significant changes for Part B but I’ve listed the Part A changes below. You can find the full press release here.
Deductibles and Coinsurance for 2016
Part A Deductible and Coinsurance Amounts for Calendar Years 2015 and 2016 Type of Cost Sharing
|Inpatient hospital deductible||$1,260||
|Daily coinsurance for 61st-90th Day||315||
|Daily coinsurance for lifetime reserve days||630||
CMS recently sent out an announcement about a new audit policy that they’re implementing for their eligibility transactions. This only affects transactions being sent through their EDI system not transactions being sent through DDE. The short version of the policy is as follows:
1. Beginning 10/1, CMS will start randomly auditing transactions in search of instances where the same NPI and HICN are sent multiple times in one day.
2. If they identfy instances where the same beneficiary is being sent excessively by the same provider, they’re going to suspend that NPI from using their eligibility system (HETS).
3. The NPI will remain suspended until a written corrective active plan is submitted to and accepted by CMS.
You should have received some version of this notification from your eligibility vendor but in case you haven’t I’ll link you to the original notice. Please take this very seriously. If you have any automated processes that will repeatedly send the same member, please consider reviewing this process.
CMS will be holding a call to discuss coding tips and updates on the status of ICD 10 this Thursday at 2:30 ET. Sorry for the short notice. See the announcement below.
Thursday, August 27; 2:30-4pm ET
To Register: Visit MLN Connects Event Registration. Space may be limited, register early.
Don’t miss the August 27 MLN Connects Call — five weeks before ICD-10 implementation on October 1, 2015. CMS Acting Administrator Andy Slavitt will be opening the call with a national implementation update. Then, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) will be joining us with coding guidance and tips, along with updates from CMS.
Target Audience: Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, skilled nursing facilities, home health agencies, and all Medicare providers.
I’m getting inundated with ICD updates from the payers and clearinghouses now that 10/1 is getting near. I thought I would share some of these from time to time.
UNITEDHEALTHCARE SYSTEM NOTIFICATION
ICD-10 Code Edits Applied By UnitedHealthcare
Oct. 1, 2015 is the compliance date for the transition to ICD-10 coding to replace ICD-9. These codes are used by physicians and health care professionals to record and identify diagnoses and procedures for claims payments. ICD-10 affects diagnosis and inpatient procedure coding only. It does not affect current procedural terminology (CPT) coding for outpatient procedures.
ICD-10 edits currently in place are shown in the grid below, subject to change prior to Oct 1. Please refer to the Enhanced Claim Edits section of UnitedHealthcareOnline.com for the complete list of edits applied by UnitedHealthcare.
Based on ANSI X12 TR3 compliance regulations, WEDI SNIP Types indicated are enhanced at a pre-adjudication level during HIPAA validation. This enables UnitedHealthcare claim submitters to identify and correct rejected information prior to the claim’s acceptance into our adjudication system for processing.
We encourage providers to check claim submission reports on a regular basis and in a timely manner. They can view tracking your electronic claims to learn more about electronic reports and rejections. The UnitedHealthcare ICD-10 website contains many tools and resources to assist submitters with the transition to ICD-10. Our newest is the Physician ICD-10 Coding Practice Tool that allows providers to practice selecting ICD-10 codes for various clinical scenarios across 35 medical specialties.
If you have any questions, please contact Electronic Data Interchange (EDI) Support:
|UnitedHealthcare Commercial UnitedHealthcare Medicare SolutionsUnitedHealthcare West||EDI transaction support form or 800-842-1109|
|UnitedHealthcare Community Plan||EDI transaction support form or email@example.com or 800-210-8315|
|UnitedHealthcare Oxfordfirstname.lastname@example.org or 800-599-4334|
*Exceptions: Harvard Pilgrim (04271), Medica HealthCare Plans (78857), Preferred Care Partners (65088), The Alliance (88461) and TRICARE West (99726)