Stephens
& Associates Transition
Well,
as of the writing of this newsletter, Stephens & Associates has
completed the transition from Gary’s offices in Ventura to the
mountains of Tehachapi, CA. For those of you who may not have heard,
Gary sent out a letter February 12th announcing his retirement. Shortly
thereafter, Adam Ziegler, the new owner of the company, sent out notices
to all of our clients with new telephone numbers and mailing addresses.
In the meantime, the
new owners here at Stephens & Associates have been burning the
midnight oil trying to make the new and improved business better than
ever. One of our new offerings is a program called “Complete
Care”. Starting March 13th, those of you who buy any practice
management program, complete with on site installation and training
from us will receive 90 days of unlimited technical support for FREE!
Validator
5.10.0 released! Blue Cross of CA submitters encouraged to update!
As
of Friday, May 5th, 2006, you can now download a free update for your
Validator program to version 5.10.0. The following enhancements have
been made to the program:
· The Main form now displays the program version at the top
· Fixed Logic in Exclude which allowed you to send files with
Zero claims
· Fixed Sort by Viewed date in Reports and Mail Screen
· Various Scripting enhancements including the ability to download
ERA files from Blue Cross of CA
· You are now able to PRINT EOB files from ERA files downloaded
(regardless of what version of Lytec you have)
· Changed Blue Cross Script to UPPERCASE the login ID for their
new 800 number
· Added capability to transmit claims via web pages
It is highly recommended that anyone submitting to Blue Cross of CA
get this update before June 3rd, when they switch to their new BBS
with the toll free telephone number.
WARNING:
Do not accept ERA files from United Healthcare!!!
Stephens
& Associates, at the request of one of our valued clients, had
the opportunity to review the Electronic Remittance files sent by
United Healthcare through THIN. We needed to find out if the files
United Healthcare were sending met the criteria for HIPAA compliance,
or if they contained erroneous information as our client had believed.
Upon close review by our technicians, we found to our extreme surprise
that the file indeed was erroneously reporting payments at the claim
detail (CPT) level. When we spoke with United Healthcare about the
issue, they explained that if the claim is being processed as a secondary,
their system is not capable of sending payment information on the
detail (CPT) level. That does not, however, stop them from SENDING
line item detail information, and when they do, they fill the provider
payment amount with the same totals as the charge amount. To clarify,
they are reporting FULL payment on all claims processed as a secondary,
regardless of actual payment amount!
As
a result of our investigation, and UHC’s response, Stephens
& Associates filed a complaint with the Office of E-Health Standards
and Services (OESS) in the Centers for Medicare and Medicaid Services
(CMS), the federal agency responsible for overseeing the non-privacy
provisions of the Administrative Simplification Act. While we are
awaiting their ruling, we are encouraged by the fact that their 835
ERA file did NOT pass the OESS initial test. We are confident that
after their official investigation, UHC will be forced to stop sending
such damaging ERA files, but until that happens, we are recommending
to all of our clients that they NOT receive these files from United
Healthcare.
Note: It should be noted that in the year and a half since
Lytec released their ERA module, this is the first case where ERA
files were found to contain erroneous information. While the acts
of United Healthcare can cause serious Accounts Receivable inaccuracies,
we would like to stress that this is a very rare and unusual problem.
Changes
for Blue Cross of CA
Validator
users are encouraged to update to version 5.10.0. This version has
several enhancements that Blue Cross users will need. We found out
the hard way that with Validator version 5.9.0, you ARE able to create
files with no claims in them, if you use the Validator’s error
checking routine to exclude all of the claims in a file. You can tell
there are no claims by looking at the “outbox”, as the
claim totals and claim count will all be zero, but some of our clients
were sending the file anyway, causing Blue Cross to get very frustrated
with us. Version 5.10.0 will remove any files with zero claims, thus
keeping you from accidentally sending them.
In
addition, version 5.10.0 was built to specifically address a letter
that was sent to all of our clients at the end of April. The letter
states that the BBS dialup number is changing from 818-703-4530 to
800-528-4845, and that the new number will require users to enter
their BBS Login ID (SPC Mailbox number) in all uppercase. Since the
Validator versions 5.9.0 and older force lowercase values in this
field, you MUST update to version 5.10.0 to continue to send to the
new BBS. You may begin to send to the new number immediately, though
you MUST stop using the old number by June 3rd, 2006.
See
what you have been missing!
Stephens
& Associates has teamed up with a popular scanner manufacturer
to offer a quality insurance card scanner for a great price with Lytec.
These scanners are specially designed to work with thicker material
such as laminated insurance cards and driver’s licenses, and
we are offering them, complete with installation setup and training
for only $199. What is even better, purchase a Lytec 2006 new program
or upgrade by June 30th, 2006, and S&A will give you the scanner
for free!
