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Latest Updates
Jun
15


On 6/10/2016, our trading partner identified a claim processing issue that impacted Professional (837P) claims for Common Ground Healthcare Cooperative, payer id 77170, from 3/15/16 to 6/10/16

If you have any outstanding claims for this payer, our trading partner is asking providers to resubmit their claims.   We apologize for the inconvenience that this may have caused. 


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May
18

Claims sent to Blue Cross Blue Shield of Minnesota between the dates of 5/8-5/15 may have failed for the following reason:

Category: Acknowledgement Returned as unprocessable claim The Claim Encounter has been rejected and has not been entered into the adjudication system Status: Prefix for entity's contract member number. Entity: Subscriber

Category: Acknowledgement Returned as unprocessable claim The Claim Encounter has been rejected and has not been entered into the adjudication system Status: Missing or invalid information

An error was identified at the payer that caused claims with the prefix of XZG to fail for the above reasons.

All affected claims have been identified and will be reprocessed automatically.  Claims can be removed from ClaimFix and do not need to be resent.


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Apr
25
BCBS SC AW1 Edit
Posted on 25 April 2016 03:38 PM
BCBS SC has been receiving a large quantity of "AW1" edits from several of your providers which means "the rendering is not present". On the CMS 1500 claim form the provider must submit the facility NPI in box 33A which is Loop 2010AA and rendering provider in box 24J which is Loop 2310 B (NM182). The rendering provider is the person or company who rendered the services.


Different scenarios:

1. The claim maybe submitted with the rendering provider NPI in the billing provider field and our system shows that the provider is affiliated to a group.
Solution:
We will need the group NPI in box 33a which is Loop 2010 AA NM109 and the rendering NPI in Box 24J Loop 2310 B.


2. The claim submitted with the rendering provider NPI in the billing provider field and our record shows that NPI is not on file.
Solution:
The provider will need to contact the Provider Data Management department for his or her region to verify if credential information is set up correctly.

North Provider Data Management 1-877-874-2273

South Provider Data Management 1-800-403-3950

West Provider Data Management 1-877-988-9378


3. The claim submitted with the rendering provider NPI in the billing provider field and in the rendering provider field.

Our records may show that the provider has a NPI affiliated to the tax id and NPI affiliated to their SSN. Both NPIs are different.
Solution:
The billing NPI and the rendering NPI cannot be the same NPI that is a compliance edit.

The claim will need to be submitted with the NPI affiliated to the tax id in box 33a, Loop 2010 AA (NM109) and the rendering provider NPI affiliated to SSN in box 24J, Loop 2310 B.

If the provider is solo and only wants to use one NPI then the provider will need to contact the Provider Data Management department for his or her region.

North Provider Data Management 1-877-874-2273

South Provider Data Management 1-800-403-3950

West Provider Data Management 1-877-988-9378


4. The claim submitted with a group NPI and our records show the group NPI is not on file.
Solution:
The provider will need to contact the Provider Data Management department for his or her region to verify if credential information is set up correctly.

North Provider Data Management 1-877-874-2273

South Provider Data Management 1-800-403-3950

West Provider Data Management 1-877-988-9378

If you have any additional questions on the AW1 edit the providers or clearinghouse can contact us at 1-800-325-5920 opt 2.

We have an interactive claim form for the CMS-1500 that gives the loops/segment information available on http://www.myTRICARE.com. In the search section on the website just enter interactive claim form and the link for the form will come up. When you select the box on the form it will take section that explains that box along with loop/segment information.
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Apr
7

Claims for various payers may have failed on 4/7/2016 for the following reason:

Payer Specific Edit: Only one line item allowed per claim FE604

Office Ally has reprocessed all affected claims.  No action required.  We apologize for any inconvenience.


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Feb
9

A technical issue occurred at NCTracks (Medicaid North Carolina, payer ID: NCXIX) that caused the daily batches sent by Office Ally from 2/2/16-2/8/16 to not be loaded into the NCTracks system.

This issue has now been resolved.  Below is the email Office Ally received from NCTracks Tech Support:

"The NCTracks issue of 837 files from 2/2/16 through 2/8/16 not picked up from Office Ally's Trading Partner mailbox has been resolved.  The 999s were created, and the files were adjudicated. We apologize for the inconvenience."

NCTracks has stated that because of this issue, payment for claims last week (week of 2/1/16-2/5/16) will be delayed until next week's check (2/15/16-2/19/16).

Additionally, to clear up any confusion, there was no issue with Office Ally's contract with NCTracks and the Office Ally NC ID did not lapse.  Prior issues with NCTracks that occurred back in February 2015 are completely unrelated to this occurrence.


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