Category Archives: Support

Urgent gGastro® Software Update for 2017 Advancing Care Information (ACI) Measures

gMed® has updated gGastro’s methodology for calculating the numerator of certain 2017 Advancing Care Information (ACI) measures as part of an upcoming gGastro software update to Version 4.62 in order to reflect performance period options for 2017 ACI measures.

It is important that you use this upcoming updated version of gGastro for your ACI attestation as the calculations in the non-updated version may not be accurate.

If you have not completed your ACI attestation, please do not do so until after you have upgraded to the upcoming updated version of gGastro. 

If you have already completed a 2017 ACI measure attestation to the Centers for Medicare & Medicaid Services (CMS), you will need to update your attestation numbers after your system has been updated and you have taken the appropriate steps to recalculate your practice’s 2017 ACI measures.  

The submission deadline for all measures, including ACI, is March 31, 2018.

If you are using a non-cloud based version of gGastro, then an additional communication will follow shortly that will allow you to schedule your update to ensure you have the latest version.

If you are using a cloud-based version of gGastro, then an additional communication will follow shortly that will notify you when we will be updating your software.

We apologize for any inconvenience that the timing of this update may cause. We are available to assist you if you have any questions.  You may call us at 888-577-8801 or e-mail us at gsupport@modmed.com.

gPM Clients: Messages from Practice Insight: Payer Change: Jurisdiction J Migration of Part A payers (Jan. 23, 2018)

PLEASE SEE MESSAGE FROM PRACTICE INSIGHT: 

Date:

Payer(s):
1/23/2018

MAAL1 – Medicare Alabama Part A
MAGA1 – Medicare Georgia Part A
MATN1 – Medicare Tennessee Part A
CMS selected Palmetto GBA as the A/B Medicare Administrative Contractor (MAC) for Jurisdiction J (JJ), which includes the states of Alabama, Georgia, and Tennessee.

Part A claims are transitioning from Cahaba to Palmetto at the end of January according to the following schedule.

Jan. 23, 2018
Last Part A claims submitted to Cahaba by 3:00pm Central.
Practice Insight will modify the programmed contractor code associated with each line of business. Practice Insight EDI payer ID codes remain the same.

Jan. 24, 2018-Feb. 2, 2018
Part A claims submission begins to Palmetto GBA using new contractor codes.
Electronic files will receive 999 and 277CA responses

Feb. 2, 2018
Normal Part A production cycles will run going forward.

Action Required by Provider:

All provider data including EDI-ERA enrollments were migrated from Cahaba to Palmetto. While the contractor codes are changing on outbound claims, Practice Insight EDI payer ID codes will remain the same.

For detailed information, please refer to the Jurisdiction J transition site:

https://www.palmettogba.com/palmetto/providers.nsf/DocsCatHome/JJ%20Transition

gPM Clients: Messages from Practice Insight: UHC Payers CPT Rejections (Jan. 23, 2018)

PLEASE SEE MESSAGE FROM PRACTICE INSIGHT:

Practice Insight received the following notification regarding claim rejections of UnitedHealthcare payers for valid CPT codes starting January 01, 2018.

—————————————————————————-
EDI Claims Rejecting in Error for Procedure Code effective January 1, 2018

OptumInsight and UnitedHealth Group have identified an issue that is causing electronic data interchange (EDI) claims with new procedure codes (CPT, NDC, HCPC) effective on January 1, 2018 to reject in error. The error message will reflect Code is not a valid CPT or HCPCS Code for this Date of Service.

OptumInsight and UnitedHealth Group will have all January 1 effective codes available for claims to process on February 2, 2018. At this time, we would recommend halting submission of EDI claims with new procedure codes effective January 1, 2018 until the codes are updated for processing use on 2/2/18. Claims with procedure codes effective before January 1, 2018 will process as normal.

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.

____________________________

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

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.

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.

gGastro C-CDA data submissions to OneHealthPort

gMed has completed the testing with OneHealthPort and confirmed the support of gGastro
C-CDA data submissions to the CDR.

The OneHealthPort Clinical Data Repository (CDR) is the Washington State Health Authority’s clinical data repository for Medicaid patients.  For more information about OneHealthPort, please visit the website: http://www2.modmed.com/e/27382/2017-02-16/78jhnd/1037694747.

OneHealthPort provides several options for secure transport of the C-CDAs to the CDR. gGastro clients will need to use the Direct Method to submit their C-CDAs.

Please download instructions on how to provide the C-CDAs to OneHealthPort.