Google recently notified me that the site has been hacked. Luckily the hackers didn’t completely hijack the site but I may need to take it down for a couple of days to do some clean up. I’ll try to give you some notice before taking everything offline. Sorry everyone. I’ll keep you posted on the outcome.
Crisis averted. The fix was much easier than I thought and it only took a few minutes.
This weekend I’m planning to replace the existing prefix lists with a brand new list. There are still some changes that need to be made but I didn’t want to hold it up any longer. There are a few things to note about the new list:
1. The pages will be organized a little differently than the current pages. All the prefixes for a particular letter of the alphabet will be on one page. Hopefully this will make it easier to find what you need and it will make it easier for me to update.
2. There were hundreds of prefixes on the new list that are no longer assigned to a plan but were in the past. I’ve left those on the site for now. They’re labeled “unassigned” where the plan name should be. If you think leaving them on the list adds clutter let me know and I can remove them.
Please see the update below from Aetna regarding checking eligibility for Walmart members. Evidently you can only check eligibility for them electronically using the name and DOB.
We’d like to let you know that using certain search criteria, users are unable to get successful real-time eligibility and benefits responses for Walmart members.
Using certain search criteria, users attempting to get eligibility and benefits details for Walmart members are receiving an error code of “Subscriber/Insured Not Found” (AAA75).
— To receive a successful response, users can use the Name/date of birth search option.
— The following search criteria will not return a successful response, that is, using these search criteria will return an error:
– Walmart ID/date of birth
– Walmart ID/name
– Walmart ID/name/date of birth
We’re in the process of identifying the root cause of this issue. We’ll send additional information after we’ve determined how to correct this issue.
A couple of quick updates for this week:
Coventry Care of Pennsylvania will be migrating their Medicaid business to Aetna Better Health effective 10/1/2014. New cards are being sent out with the new payer ID and claim address. See the top of page two of their newsletter.
I’ve see several member notifications but very little to the providers. I’ll keep you posted as they provide more info.
CMS will be changing how far in the past they will allow eligibility requests. Effective 9/28, CMS will begin limiting inquiries to 12 months in the past (vs 27 months which you can do now). Any transactions requesting eligibility through HETS with old dates of service will get rejected.
CMS posted another update to Healthcare.gov regarding providing proof of income and citizenship in order to keep coverage through the marketplace. The deadline is 9/30.
CMS sent an interesting press release a few weeks ago regarding a letter they sent to 300,000 health exchange members. These members need to provide additional information or clarify information from their original application. If they don’t respond, coverage for these members will end on 9/30/2014.
CMS is actively updating this article they posted regarding the measures they’re taking to reduce the number of appeals they have pending for inpatient stays. As I’m writing this, there’s a teleconference to explain the process. Evidently acute care facilities are eligible for a reduced payment of their charges if they withdraw their appeal.
I just added the most recent Medicare Advantage payer lists and I’ve added links to them in the side bar. Please let me know if you have any trouble downloading them.