gPM Clients: RESOLUTION Open Edge service interruption (January 19, 2018)

Open Edge has advised that the service interruption issue reported on January 18, 2018 has been resolved.

If you are still experiencing issues, please contact Open Edge Support for further assistance.

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gPM Clients: Open Edge service interruption (January 18, 2018)

Open Edge, is currently experiencing a service interruption.  The issue has been escalated and Open Edge is currently investigating the issue.

gPM Clients: Message from Practice Insight: WPS Ongoing Connectivity Issues (Jan. 18, 2018)

Please see the message from Practice Insight:

WPS ONGOING Connectivity Issues – January 18, 2018

Practice Insight has been notified by WPS that they are still experiencing intermittent server issues.

WPS is actively working to resolve the server issues, but does not have an ETA on a resolution.

This issue will delay the submission of claims and retrieval of response files (i.e. 999, 277CA, and 835/Remit files).

Practice Insight will submit all outstanding claims and download responses as soon as this issue has been resolved.

Affected Payer ids:

WPS COMMERCIAL, payer id 00235
ARISE HEALTH PLAN, payer id 39185
TRICARE EAST, payer id TREST
TRICARE FOR LIFE, payer id TDFIC
VETERANS AFFAIRS PCCC REGION 3, payer id VAPC3/VAPCCC3
VETERANS AFFAIRS PCCC REGION 5A, payer id VAP5A/VAPCCC5A
VETERANS AFFAIRS PCCC REGION 5B, payer id VAP5B/VAPCCC5B
VETERANS AFFAIRS PCCC REGION 6, payer id VAPC6/VAPCCC6

Scheduled Monthly Security Maintenance (January 20, 2018)

This is a reminder for the gMed Cloud monthly maintenance window.

SCHEDULED: January 20, 2018 between 12:00 AM – 6:00 AM Eastern Time

APPLICATION IMPACT:  All services will be potentially unavailable for the duration of the updates.

MAINTENANCE DESCRIPTION:
A maintenance window is required in order to apply mandatory security updates to our systems. This work is expected to be completed within the maintenance window.

If you experience any interruption in service after this date, please contact our Support team.

gPM Clients: Message from Practice Insight: BCBSAZ Claim Processing Change for Rendering Providers Payer Bulletin (January 5, 2018)

Effective for medical claims received on and after January 1, 2018, BCBSAZ is processing the claim using the rendering provider, when that field is populated on the claim. If the BCBSAZ system has no association between the rendering provider NPI and the tax ID on the claim, the claim will be returned. To avoid unnecessary returns and payment delays, please make certain that any rendering provider submitted on claims with your tax ID, has been added to our system.

All rendering providers with a credential that is eligible for an independent contract with BCBSAZ (such as PAs and NPs) are required to go through the BCBSAZ credentialing process. To get started, visit Contract Now! at azblue.com/providers and complete the application/information form. This will prevent claim returns and ensure that all providers associated with your tax ID are correctly loaded in our system with current contracting and credentialing information.

2018 CPT Codes Update

The 2018 CPT code updates published by the American Medical Association have gone into effect as of January 1, 2018. The gMed team has completed the 2018 CPT code updates on the centrally hosted CPT database, and they are currently available to all gMed clients without a need for an upgrade.

Please note:  If you finalize 2017 services on, or after, January 1, 2018, ​the 2018 ​CPT ​code changes will generate if applicable.

For questions reach out to gsupport@modmed.com.

gPM Clients: Message from Practice Insight: Medicaid MI Elig Rejection Issues (January 02, 2018)

Practice Insight has been notified of a processing issue by MEDICAID MICHIGAN (payer id: MCDMI, D00111).

They are experiencing a processing issue that is intermittently erroneously rejecting Real-Time requests for Eligibility & Benefits (ANSI 270) submitted starting January 2, 2018.

The rejection message is “Request is INVALID: Subscriber/Insured Not Found. Please Correct and Resubmit” and “Request is INVALID: Patient Birth Date Does Not Match our Database. Please Correct and Resubmit.”

Please DO NOT resubmit the rejected Real-Time requests for Eligibility & Benefits (ANSI 270). The payer is actively working to resolve the processing issue.

gPM Clients: Message from Practice Insight: Payer Bulletin: Tricare East and West Regions (Update)

PLEASE SEE MESSAGE FROM Practice Insight:
Payer Bulletin: Tricare East and West Regions *Update*

Payer Bulletin:
Practice Insight is sharing additional information from Tricare regarding the changes scheduled for implementation on Jan. 1, 2018. In summary:

Practice Insight will manage the submission of claims to the correct EDI contractor based on the payer ID number in the uploaded claim. However, claims with dates of service that do not correspond to the payer ID number may be stopped as Invalid.

Tricare East does require EDI registration for both claims and ERA. All Tricare North and South providers planning to submit claims to Tricare East and/or receive ERA delivery must enroll with WPS-Tricare East (TREST).

Tricare West is changing to a new administrative contractor and requires that providers re-enroll for EFT and ERA. Providers wishing to continue receiving EFT/ERA must enroll using the T2017 Tricare West instructions.

Please also refer to the following letter from Tricare to providers and EDI trading partners:

Tricare Contract Changes Letter

Additional Resources:

https://www.humanamilitary.com/provider-east 

https://www.wpsic.com/providers/index.shtml

You may also open a ticket with gSupport if further enrollment assistance is needed.

gPM Clients: Message from Practice Insight: Payer Bulletin: NEW TRICARE East Region (September 25, 2017)

PLEASE SEE MESSAGE FROM Practice Insight:
Payer Bulletin: NEW TRICARE East Region

Payer Bulletin:

The U. S. Department of Defense has awarded Humana Government Business the contract for the new TRICARE East Region. The new East Region combines the current North and South Regions for TRICARE, effective January 1, 2018. The contract work for claims administration and related activities was awarded to WPS Military and Veterans Health, the same claims and EDI contractor as TRICARE for Life and the Veterans Choice program.

Between now and the implementation date of 1/01/2018, providers serving the North and South regions are asked to prepare now for the transition of EDI processes for claims, ERA and EFT. Providers are expected to enroll anew for electronic transactions through the WPS gateway.

Action Required by Provider:

Providers utilizing Practice Insight should use the link below for the EDI/ERA enrollment instructions.

NEW Practice Insight Enrollment Instructions for TRICARE East

Note: Providers who already submit claims for TRICARE for Life or one of the Veterans Choice programs (VAPCCC), will be recognized by WPS and will not be asked for another business agreement. However, providers who are completely new to the WPS EDI gateway will receive an email with instructions to sign and return a business agreement.

Additional Resources:

https://www.humanamilitary.com/provider-east 

https://www.wpsic.com/providers/index.shtml

You may also open a ticket with gSupport if further enrollment assistance is needed.