Contact Info
Call us at (360) 975-7000
  • Customer Service - Option 1
  • Technical Support - Option 2
  • Enrollments - Option 3
  • Accounting - Option 4
  • Scheduling - Option 5
Patient Ally: (888) 747-4255 Fax: (360) 896-2151
E-mail: support@officeally.com

RSS Feed
Latest Updates
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.
Read more »



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.


Read more »



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.


Read more »



Feb
5
Blue Shield CA (BS001) CPT Code Rejections
Posted on 05 February 2016 01:40 PM

Between 1/1/16-1/31/16 Blue Shield CA (BS001) rejected claims for the following reason:

Normal-0x3939612-Value of sub-element SV101-02 is incorrect. Expected value is from external code list - HCPCS Code (130) when SV101-01='HC'. Segment SV1 is defined in the guideline at position 3700.This error was detected at:Segment Count: 39Co

While many of the rejections were valid, in some cases, this was due to the payer not adding the following codes into their system:

G0477-G0483

The codes have now been added.  If a claim received the above rejection AND contained a code within the set listed, please resubmit those claims.


Read more »



Jan
27

Claims for various payers may have failed on 1/26/2016 for the following reason:

REJECTED AT CLEARINGHOUSE PAYOR ID MISSING INVALID

These messages were erroneous and all claims should have this subsequent message:

[RESUB OF TRACE XXXXXXXXXXXXXXX] CLAIM HAS BEEN FORWARDED TO PAYER FOR CONTINUED PROCESSING

These claims can be removed from claim fix.  We apologize for any inconvenience. 


Read more »




Help Desk Software by Kayako Fusion