Stephens & Associates has completed
testing with Empire BCBS of New York for the HIPAA compliant ANSI
format for NEIC. This carrier is designed specifically for those
who are currently submitting to Empire Medicare for New York through
their
IVANS system, and works very much like THIN does, in that it can
be used to submit any number of commercial payers electronically.
This
is available as a free download to anyone who is submitting to Empire
Medicare using the Validator5 program. We have put together a
few pieces of information, which you will need
to know in order to be successful in sending your claims electronically
to NEIC through Empire.
Making sure your
Validator5 program is ready
Usually we release new carriers in conjunction with a program update,
but given the extremely short period of time that Empire provided
for testing after they decided to upgrade to a HIPAA compliant format,
we wanted to make this available before our next program update. As
a result, the process is a little more complicated than it otherwise
would be. If, after reading these directions carefully, you feel as
though you are unable to go through this process yourself, feel free
to contact your friendly neighborhood Validator support person for
assistance.
The first thing you
want to do BEFORE running either NEIC patch, however, is to update
your Validator
program
to the most current version. Open the Validator program and choose
"Help\About Validator5" from the main menu. If it does not say
at least
version 5.9.0, you need to update the Validator program. The 5.9.0.
Update can be found at Validator
5.9.0 Update for Lytec.
Next you want to make sure you already
have a “Carrier Module” installed for NEIC. If you
have been submitting to NEIC claims already using Validator5,
you are ready
to go. If you have not, you will want to go to "Settings\Add-Remove
Carriers" and add NEIC to your list of carriers. Then you will
want
to go to "Settings\Carrier Setup Options" and make sure you enter
the information for that carrier. Your Submitter ID is usually
the
same
for NEIC as it is for Empire Medicare, though you likely will need
to obtain a new Activation Key from your Validator Reseller.
Finally, we need to discuss the matter
of Payer IDs. Payer IDs allow the Validator program to properly
route
claims to the appropriate payer. By default, THIN is the appropriate
carrier module to use for all commercial claims. This will not
change
in our Validator distribution files. To use NEIC you will need
to make some modifications yourself. To do this, go to "Utilities\Receiver
IDs" and enter
the
password
IAMTECH and do one of the following:
1. If you want ALL of your commercial
claims to go through NEIC instead of THIN, choose the [Change
Multiple] button. Where it says “update all entries pointing
to” make sure it says “TC = THIN Commercial”.
Where it says “to instead use the following carrier module”
choose “NE = NEIC”. Then press the [Update] button, and
then press [Done].
2. If you still plan on using THIN for many claims, and just want
a few carriers to go through NEIC (like Americhoice, GHI, etc),
you
can press the Add button and add each NEIC Payer ID separately, pointing
each one to NE = NEIC.
Updating the
support files for NEIC
There are two patches, which need to be downloaded in order to obtain
the ability to submit to NEIC. The first NEIC patch will update
a
support table called ANSI_SEG in order to allow for the additional
segments that Empire requires for this format, and can be found
at
NEIC
Part 1
You should simply run this update from its current location. The
second update will give you the ANSI capable Matrix and Valid tables,
as
well as your new Lytec form file, and can be found at NEIC
Part 2.
Just like the first patch, you should simply run this and follow
the prompts. Remember that if you have your Validator program installed
to any place other than the default directory of “C:\Program
Files\Validator5\” you will need to change this information
as you run each patch. If you are unsure, you may right click on
your
Validator5 shortcut icon on your desktop. If it says anything other
than “C:\Program Files\Validator5\Validator5.exe” then
you have installed to a non-default location.
Making Sure the
Lytec Custom Form File for NEIC is in the Right Place
Once you have downloaded and installed both patches, you will want
to “refresh” your form files. This will copy the form
file we created JUST for NEIC over to the appropriate folder in
your
Lytec program. To do this, go into the Validator program, choose
"Settings\Carrier Setup Options" and choose "NEIC" from the dropdown
menu. Click on the
form files tab, and locate the form file called, “_NEIC 4010A1
Rev1.lns”. Highlight it and press the [Refresh]
button. Choose [Yes], and [OK].
Making Sure Lytec is set up
Correctly for NEIC
Although the ANSI format was supposed to standardize the format by
which claims are accepted nationwide, some of the insurance carriers
which the Validator5 program supports have implemented their own
unique edits which are allowed under some of the looser interpretations
of
the ANSI file structure, and in the case of NEIC, some of which are
blatantly against HIPAA, but must be followed anyway. As a result,
it was unfortunately necessary to create a separate form just for
NEIC. In addition, there were some additional fields that were necessary
in order to be able to send claims electronically to NEIC through
Empire. Normally, when we send claims to a carrier, we include the
Provider’s Insurance ID number that would normally be needed
to receive payment from that specific carrier. For example,
we
would send a Medicare PIN number to Medicare, while sending a state
license or Tax ID to a commercial carrier. For NEIC claims, however,
Empire requires us to send the provider’s Empire Blue Cross
Blue Shield provider ID, and their "Site ID", so that they know
it is
OK to forward these claims without first collecting payment from
you. We pull these fields from Provider Custom Fields 6 and 7, respectively.
If you want to use a different field for this, you will need to have
your Validator support representative modify your Lytec form.
Other things to consider in
Lytec
Other than those IDs, you will of course want to make sure the proper
payer ID numbers are in each insurance company record. In addition,
you should be aware that as a result of some payer specific edits,
we are including the Rendering Provider Loop on EVERY claim. This
was necessary in order to make sure that claims will go through, and
we have been assured that even claims for non-group providers should
have no problem with this.
Finally…
When you generate a batch of claims, you will want to use the latest
revision of the NEIC 4010A1 form, currently “_NEIC
4010A1 Rev1.lns”. Other than that, the procedure
is the same as you are currently using for Medicare and Blue Cross/Blue
Shield.
