Beacon Health Options (Beacon), in collaboration with Office Ally, has upgraded its electronic claims submission application effective April 17, 2019. 

The upgraded claims submission process includes the implementation of new claims edits. These edits are in line with industry standards and designed to ensure that claims submitted to Beacon have all of the data elements required to be considered clean claims, and pass HIPAA standards published by The Centers for Medicare and Medicaid Services (CMS). Office Ally is currently working to systematically address rejections related to claims that contain the same Billing Provider NPI and Service Facility NPI.

In the event that a claim fails the edits, you will receive a standard response back from Office Ally. Included in that response will be the reason the claim cannot be processed.

A completely unrelated event on Beacon’s side caused Office Ally not to be able to access response files between 4/17/19 and 5/08/19. The issue has now been resolved and the responses are now being received as planned.

Should you have questions or concerns, please feel free to reach out to our EDI Helpdesk via

888-247-9311 or via email at e-supportservices@beaconhealthoptions.com. 

Date:

May 2, 2019

Purpose:

We’d like to tell you about certain home health claims we previously rejected.

Overview:

In March, we identified an issue with Medicare Advantage home health claims. The claims had service dates in 2018 and 2019, and all were received on or after March 7, 2019, with the new value code 85 (“County Where Service Is Rendered”). In our claim status responses, we rejected the claims due to the 2018 dates of service and returned the following 277 values:

• A7: Acknowledgement/Rejected for Invalid Information – The claim/encounter has invalid information as specified in the Status details and has been rejected.
• 726: NUBC Value Code Amount(s)

We corrected the issue in our internal systems on April 29, 2019, to allow the new value code to apply to 2018 dates of service. Starting May 1, we started resubmitting electronic claims through our internal claim intake process. Therefore, providers won’t have to resubmit these claims to us.

Once we reprocess the claims, we’ll assign a new Aetna claim ID and return new 277CA codes. We’ll retain the vendor’s original clearinghouse trace number (2300:REF02 when REF01 = D9) and the provider’s submitted patient account number (2300:CLM01).

Action requested:

This communication is for your information.

Questions?

Please direct any general questions to the EDI Assistance Center mailbox.

Date:

Sunday, March 31, 2019

Real Time:

Submitters of Real Time transactions may experience timeouts for Real Time Eligibility, Claim Status Inquiry, Precert Add & Inquiry, and Referral Add & Inquiry transactions on Sunday, March 31, 2019 from 5:00 AM ET to 8:30 AM ET.

Impact:

Low

Questions: Please direct any questions to the EDI Production Control mailbox. EDI Production Control will respond between the hours of 7:00 AM – 4:00 PM. For connectivity/timeout issues after the change, please contact Aetna Mission Control at 1-888-676-2277.

Update:

Good Morning,

As to the alert listed below, BSC Promise was able to identify the concern around double deposits made to providers.

A fix was created, tested and deployed to production the evening of March 19^th..

EFT files were held beginning 3/14 until this fix was implemented and said files were released for funding to our bank, yesterday, March 20^th.

Please continue to advise providers to hold onto their funds until they are contacted as to how recoupments will be conducted. An update as to how we will proceed with these recoupments will be communicated tomorrow, March 22^nd.

Again, we thank you for your partnership in assisting communicating this alert to our providers.

Thank you!

EDI Help Desk Blue Shield of California 800-480-1221 

Blue Shield of California is an independent member of the Blue Shield Association

Summary:

Aetna ERA file delivery for today, Wednesday, March 20, 2019 is delayed. An update communication will be sent when ERA’s have been delivered.

Action:

None. For your information only.

Questions:

Please direct any questions regarding this issue to EDIProductionControl@aetna.com. EDI Production Control will respond between the hours of 7:00 AM – 4:00 PM ET. If the issue is resolved after 4:00 PM ET, an update communication will be sent the following day.

Date:

March 15, 2019

Update:

Aetna would like to provide you with updated information about an issue which affected some Medicare claims from February 8, 2019 to March 5, 2019. The issue affected certain electronic remittance advice (ERA) Claim Adjustment Reason Codes (CARCs) that caused incorrect patient financial responsibility to be reported to providers who receive ERAs from us.  As stated on March 13^th, Aetna will reissue new ERAs for those affected by the issue.

·        Beginning this evening (Friday 3/15) after 5:00pm ET, Aetna will start releasing the new 835 (ERA) files to replace the affected files. Aetna expects the new files will continue to be released through early next week.

·        The new files will contain the corrected industry standard codes in the service level CAS Service Adjustment segments. The new ERAs will be identical to the original, except that, the incorrect Claim Adjustment Reason (CARC) code will be replaced with the intended CARC code ‘45’ (“Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement”).

Aetna understands the replacement files does not follow the standard ERA protocol of providing a reversal/correction pair to reverse the original claim prior to sending corrected data; however in the interest of rectifying the issue without causing major delays Aetna feels this is the best option.