Past and present system alerts for Medicare Part B.
November 19, 2008
Attention New Jersey Part B Providers
A system problem occurred with the HIGLAS payment cycle for New Jersey Part B that reduced the number of payments made from last night's (11/18/08) batch cycle. We are currently researching the issue with the Shared System Maintainer, IBM and the EDC. An update will be provided once the issue and a corrective action are identified. Please note, payments not impacted by the HIGLAS issue were validated and will be released. We apologize for any inconvenience this has caused.
November 13, 2008
ATTENTION Part B - IVR Availability
The IVR will not be available on Friday after 4:00 PM EST and Saturday due to transition activities. The PA, MD, DCMA and DE IVR will be available on Monday morning. Due to the dark day, the NJ IVR will not be available until Tuesday morning.
October 22, 2008
Clinical Lab and Radiology Services Denied Incorrectly for MD/DCMA/DE Part B
UPDATE (10/22/08): Highmark Medicare Services has initiated adjustments for all incorrectly processed claims that resulted from this issue. The adjustments will be processed through the normal adjustment claim process and CWF before finalizing. Payment will be issued as appropriate and notice will be issued on the provider's remittance advice. This will be the last update for this issue. Again, we apologize for any inconvenience this has caused.
UPDATE(10/09/08): On 9/27/08, the CWF System Maintainer correctly cancelled the vast majority of impacted claims. There are still approximately 65 beneficiaries that require claim cancellations by the CWF System Maintainer and these should be corrected over the next two to three weeks. However, Highmark Medicare Services will begin the MASS adjustment process for those claims that can be adjusted on 10/13/08. It will take several weeks for Highmark Medicare Services to initiate adjustments for all impacted claims including those that still must be corrected by the CWF System Maintainer. We will provide an additional update to the status of this project later in October.
UPDATE (8/27/08): On 8/27/08, CMS authorized the CWF System Maintainer to begin programming changes to cancel the Trailblazer's claims at CWF from the 7/10/08 batch cycle. It is anticipated that the cancelling of the claims at CWF should occur the weekend of 10/4/08. Once the claims are cancelled at CWF, Highmark Medicare Services will automatically initiate the adjustment of claims that incorrectly denied due to the duplicate CWF records.
Original Article (8/15/08): An issue has been identified concerning certain clinical laboratory and radiology services that are incorrectly denying with Ref Remark Code N347 indicating that the service was paid by another contractor. The denials are resulting from claims that were posted to the Common Working File (CWF) from the TrailBlazer's 7/10/08 batch cycle for MD/DCMA/DE Part B claims. The CWF reply file from the posting of those claims was not entered into the first batch cycle for Highmark Medicare Services by the Enterprise Data Center. When Highmark Medicare Services resent the same claims to CWF in an attempt to repost for payment, CWF rejected the claims as having already been approved for payment by TrailBlazer. These CWF rejections resulted in incorrect claim denials. Highmark Medicare Services will identify the claims impacted by the incorrect denial and will automatically adjust the claims for proper payment. Additional information concerning the recovery process will be posted to our website when available. We apologize for any inconvenience this has caused
October 17, 2008
IVR for PA Part B Offline This Weekend
Due to J12 transition activities in our Pennsylvania Part B system this weekend, the IVR for PA Part B will not be available on October 18 and October 19, 2008. The IVR will be back on line at its normal time, 6:00 am eastern time on Monday, October 20, 2008. We apologize for any inconvenience.
October 9, 2008
Clinical Lab and Radiology Services Denied Incorrectly for MD/DCMA/DE Part B
Update (10/09/08): On 9/27/08, the CWF System Maintainer correctly cancelled the vast majority of impacted claims. There are still approximately 65 beneficiaries that require claim cancellations by the CWF System Maintainer and these should be corrected over the next two to three weeks. However, Highmark Medicare Services will begin the MASS adjustment process for those claims that can be adjusted on 10/13/08. It will take several weeks for Highmark Medicare Services to initiate adjustments for all impacted claims including those that still must be corrected by the CWF System Maintainer. We will provide an additional update to the status of this project later in October.
UPDATE (8/27/08): On 8/27/08, CMS authorized the CWF System Maintainer to begin programming changes to cancel the Trailblazer's claims at CWF from the 7/10/08 batch cycle. It is anticipated that the cancelling of the claims at CWF should occur the weekend of 10/4/08. Once the claims are cancelled at CWF, Highmark Medicare Services will automatically initiate the adjustment of claims that incorrectly denied due to the duplicate CWF records.
Original Article (8/15/08): An issue has been identified concerning certain clinical laboratory and radiology services that are incorrectly denying with Ref Remark Code N347 indicating that the service was paid by another contractor. The denials are resulting from claims that were posted to the Common Working File (CWF) from the TrailBlazer's 7/10/08 batch cycle for MD/DCMA/DE Part B claims. The CWF reply file from the posting of those claims was not entered into the first batch cycle for Highmark Medicare Services by the Enterprise Data Center. When Highmark Medicare Services resent the same claims to CWF in an attempt to repost for payment, CWF rejected the claims as having already been approved for payment by TrailBlazer. These CWF rejections resulted in incorrect claim denials. Highmark Medicare Services will identify the claims impacted by the incorrect denial and will automatically adjust the claims for proper payment. Additional information concerning the recovery process will be posted to our website when available. We apologize for any inconvenience this has caused
September 8, 2008
Claims Denied for Provider Not Eligible/Certified for PA Part B
UPDATE: As of August 1, 2008, we have reprocessed all identified claims impacted by this error. If you identify any claims that you believe should have been reprocessed, please contact the Highmark Medicare Services Appeals Department. We appreciate your patience as we worked through this corrective action.
UPDATE: As of July 18, 2008 we have reprocessed over half of the claims denied in error. We anticipate that all impacted claims will be completed within the next week. We will continue to provide you periodic updates.
ORIGINAL MESSAGE: On June 12, 2008, Highmark Medicare Services Inc. erroneously denied claims and adjustments with message B7 - This provider was not certified/eligible to be paid for this procedure/service on this date of service. This message will be shown on the standard provider remittance (SPR) of the claim and/or adjustment. The adjustment activity on previously paid services automatically generated a demand (refund) request through the Healthcare integrated General Ledger Accounting System (HIGLAS).
After reviewing several options to correct this situation, Highmark Medicare Services Inc. has decided to mail the demand (refund) letters. The impacted providers need to repay the amount indicated in the demand (refund) letter to Medicare. If you wish to request immediate offset, please call 1-888-291-2623. All impacted claims and adjustments will be re-adjusted to pay as appropriate under a separate payment. We understand this is an inconvenience to the provider community and apologize, however due to claims processing limitations, this is the most efficient way to resolve this issue.
August 19, 2008
Limiting Charge Letters Distributed
Early in August our claims processing system inadvertently allowed the distribution of limiting charge monitoring letters. Several years ago, the CMS discontinued the Limiting Charge Exception Report and the sending of compliance monitoring letters. Carriers are only required to assist beneficiaries in obtaining overcharge refunds from providers when brought to their attention. If you received a monitoring letter with instructions to refer to a limiting charge exception report, please disregard it as it was sent in error. You will not be receiving a report.
Clinical Lab and Radiology Services Denied Incorrectly for MD/DCMA/DE Part B
UPDATE: On 8/27/08, CMS authorized the CWF System Maintainer to begin programming changes to cancel the Trailblazer's claims at CWF from the 7/10/08 batch cycle. It is anticipated that the cancelling of the claims at CWF should occur the weekend of 10/4/08. Once the claims are cancelled at CWF, Highmark Medicare Services will automatically initiate the adjustment of claims that incorrectly denied due to the duplicate CWF records.
An issue has been identified concerning certain clinical laboratory and radiology services that are incorrectly denying with Ref Remark Code N347 indicating that the service was paid by another contractor. The denials are resulting from claims that were posted to the Common Working File (CWF) from the TrailBlazer's 7/10/08 batch cycle for MD/DCMA/DE Part B claims. The CWF reply file from the posting of those claims was not entered into the first batch cycle for Highmark Medicare Services by the Enterprise Data Center. When Highmark Medicare Services resent the same claims to CWF in an attempt to repost for payment, CWF rejected the claims as having already been approved for payment by TrailBlazer. These CWF rejections resulted in incorrect claim denials. Highmark Medicare Services will identify the claims impacted by the incorrect denial and will automatically adjust the claims for proper payment. Additional information concerning the recovery process will be posted to our website when available. We apologize for any inconvenience this has caused.
August 15, 2008
Incorrect Denials for Dietitians and Nutritionists in MD/DCMA/DE Part B
Highmark Medicare Services has identified an error with the provider type that was assigned by Trailblazer in the Part B shared system for dietitians/nutritionists in the MD/DCMA/DE Part B jurisdictions. This error has caused some claims for Dietitians and Nutritionists to be denied incorrectly. Highmark Medicare Services has corrected the provider type in the shared system and will be identifying and automatically adjusting any impacted claims. We apologize for any inconvenience.
August 13, 2008
Paper Check Printing Problem
The printing problem related to Pennsylvania Part B checks dated 08/07/2008 and in the check range 049002755 through 049003147 has been resolved and these checks may be deposited at the bank. The issue concerned the number on the hard copy check and the corresponding number that had been provided to the bank. The check numbers at the bank and on the hard copy checks are now in snyc, thus the checks may be deposited. We apologize for any inconvience.
August 08, 2008
PA Part B Paper Checks
Highmark Medicare Services experienced a printing problem with Pennsylvania Part B provider paper checks dated 08/07/2008. Highmark Medicare Services checks numbered 049002755 through 049003147 contain incorrect check information that will not be accepted by the bank. Please do NOT present these checks to your bank until further notice. We are working with the appropriate system areas to determine if the check files can be corrected so that these checks can be successfully negotiated. A follow up notice will be issued as soon as possible announcing the final resolution to this problem.
August 07, 2008
Some NPIs Omitted From MD/DE/DCMA Part B Crosswalk Files
Update:
We have completed our analysis of the problem associated with the missing NPI matches from the crosswalk file for DE/DCMA/MD Part B. We have identified approximately 300 instances where TrailBlazer had requested Maricom (NPI Crosswalk Contractor) perform temporary manual updates to the NPI crosswalk file to alleviate crosswalk problems. Providers were also to be informed by TrailBlazer to update either their NPPES file or their provider file to create a permanent fix to the NPI crosswalk file. During the MD/DE/DCMA Part B transition, Maricom's process for building the new J12 MAC NPI crosswalk file included removing any temporary fixes that had been requested by TrailBlazer. The removal of these fixes by Maricom has caused claims to reject if a permanent fix had not been implemented prior to the transition.
Highmark Medicare Services worked with the Centers for Medicare & Medicaid Services (CMS) and Maricom to develop a plan to restore these temporary fixes. If impacted by this NPI crosswalk problem, you or your Submitter will hear from us on the timeline for this restoration so that any previously rejected claims can be resubmitted. We will subsequently follow-up with the impacted provider to determine a permanent fix to the problem.
Original Message:
We are aware of a recent problem that caused some NPIs to be omitted from the Part B DE/DCMA/MD crosswalk files. This problem was the basis for unexpected claim rejections for some of our customers. Please be assured that we are in the process of identifying the root cause of this problem and will take appropriate corrective actions as expeditiously as possible. We will continue to provide periodic updates and apologize to all affected customers for the inconvenience.
July 22, 2008
Attention Maryland, Delaware and District of Columbia ERA Customers:
Update:
The X12N 835 Electronic Remittance Advice (ERA) files are now available for retrieval from your electronic mailbox on the Stratus Telecommunication Server. Thank you for your patience. To continue the validation process, the ERA files for retrieval tomorrow, July 23rd, will also be delayed. We will notify you when the files become available.
Original Message:
Due to the Enterprise Data Center (EDC) transition for Jurisdiction 12, the X12N 835 Electronic Remittance Advice (ERA) for retrieval today, July 22nd, is delayed to validate accuracy prior to distribution. Typically, Highmark Medicare Services expects to deliver these files to your electronic mailbox on the Stratus Telecommunication Server by 8:30 A.M. Eastern Time, but the delivery is delayed today due to this transition. A follow-up listserv will be sent when the files are available for retrieval. We apologize for any inconvenience.
July 3, 2008
Denied Claims
At the time of the system problem, if you had an appeal pending for a claim that had previously been denied, the impacts to you would be different than those where the claim denied and is being reprocess for payment. Providers who expected to receive payment for the appealed services instead received a refund requests. Individual contacts are being made to those impacted providers to explain the actions that need to be taken. Once again, we apologize for the inconvenience this has caused.
Attention Part B EDI Customers:
Due to a technical problem at the Enterprise Data Center (EDC), the delivery of the MCS Edit reports and the ANSI ASC X12N 835 Electronic Remittance Advice(ERA) dated July 2, 2008 are delayed and not yet available. A follow-up listserv will be sent when the reports and ERAs are available. We apologize for any inconvenience.
July 2, 2008
Denied Claims (Update)
As of July 2, 2008 we have reprocessed a third of the claims denied in error. We anticipate that all impacted claims will be completed within the next two weeks. We will continue to provide you periodic updates.
June 18, 2008
Denied Claims (Update)
On June 12, 2008, Highmark Medicare Services Inc. erroneously denied claims and adjustments with message B7 - This provider was not certified/eligible to be paid for this procedure/service on this date of service. This message will be shown on the standard provider remittance (SPR) of the claim and/or adjustment. The adjustment activity on previously paid services automatically generated a demand (refund) request through the Healthcare integrated General Ledger Accounting System (HIGLAS).
After reviewing several options to correct this situation, Highmark Medicare Services Inc. has decided to mail the demand (refund) letters. The impacted providers need to repay the amount indicated in the demand (refund) letter to Medicare. If you wish to request immediate offset, please call 1-888-291-2623.
All impacted claims and adjustments will be re-adjusted to pay as appropriate under a separate payment. We understand this is an inconvenience to the provider community and apologize, however due to claims processing limitations, this is the most efficient way to resolve this issue.
June 16, 2008
ATTENTION! Denied Claims
We have identified a system problem that caused claims processed last Thursday night (June 12) to deny for non certified/eligibility for the dates of service on the claim. We are currently researching this issue and will post more information as it becomes known.
You are not required to take any actions at this time.
June 9, 2008
MCS Edit Report Delayed for Pennsylvania Part B Customers - FINAL UPDATE
Attention Pennsylvania EDI Customers: The MCS Edit Reports for any claims received between 4 pm on June 2, 2008 and 4 pm on June 3, 2008 are now available for retrieval. We apologize for any inconvenience this delay may have caused.
June 5, 2008
MCS Edit Report Delayed for Pennsylvania Part B Customers - UPDATE
Due to a repeated system issue, the MCS Edit Reports for any claims that were received between 4 pm on June 2, 2008 and 4 pm on June 3, 2008, are not yet available for retrieval. They should be available for retrieval tomorrow, June 6, 2008. This is a report delay only, please do NOT resubmit the claim files. Thank you for your patience.
June 4, 2008
MCS Edit Report Delayed for Pennsylvania Part B Customers
Attention Pennsylvania EDI Customers:Due to system issues, the MCS Edit Reports for retrieval today, June 4, 2008, are not available. The MCS Edit Reports for any claims that were received between 4 PM on June 2, 2008 and 4 PM on June 3, 2008, should be available for retrieval tomorrow, June 5, 2008. We apologize for any inconvenience this delay may cause.
May 6, 2008
Attention: Pennsylvania Part B EDI Customers
The PA Part B MCS Edit Reports for claim files submitted yesterday, May 05, 2008, are currently not available. We are in the process of resolving the issue and we will notify you when the reports are available. We apologize for any inconvenience.
April 29, 2008
Limited ERA Files Unavailable - UPDATED 04/28/08
Attention Part B Providers:
Due to system issues, a limited number of Electronic Remittance Advice (ERA) files were not available for retrieval on 04/08/2008, 04/09/2008 and 04/10/2008.
All files have now been recreated. The majority of these files were recreated on 04/15/2008. Any outstanding files were recreated on 04/28/2008. We apologize for the delay and any inconvenience this may have caused. Thank you for your patience.
April 17, 2008
Limited ERA Files Unavailable - Update - REVISED
Attention Part B Providers:
Due to system issues, a limited number of Electronic Remittance Advice (ERA) files were not available for retrieval on 04/08/2008, 04/09/2008 and 04/10/2008.
The majority of these files have been recreated and are available for retrieval today, 04/15/2008. A few ERA files are still in the process of being recreated. Once the remaining files are available, another update will be provided. We apologize for any inconvenience.
April 9, 2008
Limited ERA Files Unavailable
Attention Part B Providers: Due to system issues, a limited number of Electronic Remittance Advice (ERA) files were not available for retrieval on 04/08/2008 and 04/09/2008. We are in the process of identifying those impacted and working with our system maintainers to correct this issue as soon as possible. Resolution details will be provided once available. We apologize for any inconvenience.
April 2, 2008
ERA files Delayed for Pennsylvania Providers - PA Part B Only
The Electronic Remittance Advice (ERA) files dated April 1, 2008 for Part B Pennsylvania Providers are currently not available. We are researching the delay and we will provide more details as soon as they are available. We apologize for any inconvenience.
March 19, 2008
PA Part B MCS Edit Reports Delayed
The PA Part B MCS Edit Reports for claim files submitted 03/18/2008 are currently not available. We are in the process of resolving the issue, and we will notify you when the reports are available. We apologize for any inconvenience.
February 15, 2008
Attention EDI Billers! M012 and M013 Rejections - UPDATE
The issue identified on February 14, 2008, regarding invalid M012 and M013 rejections on the MCS Edit Report for EDI claims containing an "NPI Only" has been resolved. Only providers who submitted EDI claims between 4PM on February 12 through 4PM on February 13, 2008, using only an NPI without a Medicare Legacy ID were impacted. Those providers submitting both an NPI and a PIN were not impacted.
If you submitted EDI claims during this timeframe with an NPI only and the claims rejected with Edit M012 and M013 on your MCS Edit Report, you must resubmit the claims. You may resubmit your claims now since the issue has been resolved. Again, we apologize for the inconvenience.
February 14, 2008
Attention EDI Billers! M012 and M013 Rejections
An issue has been identified with EDI claims with a receipt date of February 13, 2008, containing an "NPI Only." This issue has caused the EDI claims submitted between 4PM on February 12 through 4PM on February 13, 2008, to reject incorrectly against two NPI-related EDI rejection edits (M012 and M013). Only providers who submitted EDI claims using only an NPI without a Medicare Legacy ID were impacted. Those providers submitting both an NPI and a PIN were not impacted. EDI claims that were rejected with Edit M012 and M013 on your MCS Edit Report must be resubmitted after the issue is resolved.
When the issue is resolved, we will notify you so you can resubmit your rejected EDI claims at that time. Please do not resubmit your rejected EDI claims until instructed to do so. We apologize for the inconvenience.
February 4, 2008
Claim Accessibility Issues
Due to a system problem at the Enterprise Data Center, some claims currently may not be accessible via the IVR or by our Customer Service Representatives. If you attempt to access a claim via the IVR and get a message that it cannot be found, please do not select the option to speak with a CSR since they also will not be able to access the information. An anticipated correction time is not known. We will update this message as we received additional information. We apologize for any inconvenience.
December 27, 2007
IVR Outage - UPDATE
Due to a Pennsylvania Part B System batch cycle problems at the Enterprise Data Center, the PA Part B IVR was not fully functioning today, December 27, 2007. The problem has been corrected and as of 12:55pm, the IVR should now be fully functional. We apologize for any inconvenience.
IVR Outage
Due to a Pennsylvania Part B System batch cycle problems at the Enterprise Data Center, the PA Part B IVR is not fully functioning today, December 27, 2007. The anticipated up time for full PA Part B IVR availability is 1:00pm eastern time. We will update this alert as more information becomes available. We apologize for any inconvenience.
October 19, 2007
Incorrect Denials
Highmark Medicare Services has identified that claims and adjustment claims containing a beneficiary name and Health Insurance Claim (HIC) number mismatch were incorrectly denied from 10/01/07 through 10/12/07. This denial was the result of an incorrect setup for an edit that generates for this mismatch error. Highmark Medicare Services has corrected the edit error and are currently working to identify and adjust any incorrectly processed claims. As more information is identified, we will update this alert. We apologize for any inconvenience this issue has caused.
August 10, 2007
Part B IVR Outage
Due to extended system maintenance, the Part B IVR will not be available starting at 4:30 on 8/10 through the remainder of the weekend. We apologize for any inconvenience this has caused. Normal operations will resume at 7:00 AM on Monday 8/13.
July 30, 2007
Immediate Offset Requests
If you called Highmark Medicare Services Immediate Offset line (1-888-291-2623) requesting immediate offset, there was trouble with the line. We lost all messages from Wednesday, July 25, 2007 through 9:00 am the morning of Friday, July 27, 2007. The line is now working. If you left a message for immediate offset on Wednesday through 9:00 am Friday, we are asking that you fax those requests into our office. We are making three fax lines available - (717) 302-3823, (717) 302-3807 and (717) 302-4273. Thank you. We apologize for any inconvenience this matter may have caused.
June 28, 2007
Stratus Telecommunication Server Unavailability
Due to system maintenance, Stratus will be unavailable for all electronic transactions, including claim submission and report retrieval, on Sunday, July 1, 2007, from 6:00 PM through 7:00 PM. We apologize for the inconvenience.