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Latest Updates
Jan
30
Cigna HealthSpring 63092 (12/13/14-1/21/15 Batches)
Posted on 30 January 2015 11:56 AM

We received information from the Cigna HealthSpring (Payer ID 63092) on 1/19/15 that claims sent between 12/13/14-1/21/15 may have rejected for the following reason:

MEMBER NOT ON FILE

Some claims were rejected in error.  The payer is identifying all affected claims and will be reprocessing on their end.  No need to resubmit.  Please check claim status at the payer in 5 business days to verify if claim has been reprocessed.

Please Note: Not all claims rejected in error.  If the claim is still not on file, please verify the ID at the payers end.  If they verify it is correct please contact our customer service department either by phone (360-975-7000 opt 1), by email (info@officeally.com) or via or Live Chat (link to the left) so a ticket can be opened.  Need to have a copy of the patient's ID card ready to fax in.


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Jan
22
Blue Cross CA BC001 (12/13/14-1/15/15 Batches)
Posted on 22 January 2015 06:05 PM

Blue Cross sent out this notification on Monday, 1/19/15:

Important Information Regarding: Inpatient Behavioral Health claims are rejecting in error for edit 60401.

We identified and resolved a processing issue for inpatient Behavioral Health claims files sent December 13, 2014 through January 15, 2015 that were erroneously rejecting.

You may have been impacted in error for the following edit:

60401: Facility Code (Loop 2300 CLM05) equals 11X or 21X, at least one accommodation revenue code 010X or 021X (Loop 2400 SV201) must be provided.

Please do not resubmit the claims that rejected for edit 60401, Anthem will proactively resubmit the claims for processing. If your Level 2 Report with the 60401 edit includes additional claim rejections, correct the other errors and resubmit those claims for processing.

We apologize for any inconvenience and appreciate your patience in this matter.
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Jan
20
United Healthcare (1/1/14-1/20/14 Batches)
Posted on 20 January 2015 05:24 PM

EDI Claims Rejecting in Error with Reason Code H51000 or H54264

UnitedHealth Group identified a system issue that is causing electronic data interchange (EDI) claims with new HCPCS codes effective on Jan. 1 to reject in error.  Claims with the following HCPCS codes are being rejected most frequently: G6031, G6056, G6058, and J1071. The error and message is:  H51000 The Procedure Code is not a valid CPT or HCPCS Code for this Date of Service.

 

Additionally, claims are being rejected incorrectly with the message: H54264 Claim Adjustment Reason Code ‘23’ can only be used with Claim Adjustment Group Codes ‘OA’.

 

A system update at United HealthCare will be implemented on the evening of Jan. 20 to fix these issues. It is recommended that providers hold impacted claims until Jan 21. Claims can be resent after that date.


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Jan
14

Yesterday, 1/14/15, some claims rejected for the following reason:

Other Subscriber zip or State invalid (FE362)

This was an error on our side and affected claims need to be resubmitted.  We apologize for any inconvenience.


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Nov
17
Medicaid Oklahoma (MCDOK) ERAs week of 11/12 and 11/19
Posted on 17 November 2014 01:54 PM

The following message was posted from Medicaid Oklahoma:

The electronic remittance advice functionality is temporarily unavailable. Providers will receive paper remits for the 11/12/14  and 11/19/14 week's financial cycles. Both remits will be mailed this week. We apologize for any inconvenience.

Please note: This issue is only for Mediciad Oklahoma for the dates above.  This will not affect any other payers, remits or dates.


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