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.

Aetna Provider eSolutions Vendor Communication

Date:

March 8, 2019

Purpose:

Aetna like to tell you about issues they experienced with the mapping of certain electronic remittance advice (ERA) Claim Adjustment Reason Codes (CARCs) that affected how patient financial responsibility was reported to providers who receive ERAs from us. This issue affected some Medicare claims from February 8, 2019 to March 5, 2019, for certain remit codes.

Overview:

On February 8, 2019, Aetna changed how some of our internal claim remit codes are mapped to electronic remittance advice (ERA) Claim Adjustment Reason Codes (CARCs). Remit codes that would normally map to CO 45 were mapped to CO 1, CO 2 or CO 3. This updated mapping caused confusion for some providers, and they’ve been incorrectly billing members for deductibles, coinsurances and copays.

Aetna has restored the mapping on March 6, 2019. Going forward, this should resolve any provider confusion. However, Aetna has already sent ERA files between February 8 and March 5 that may cause members to be billed by mistake.

Though the CARCs Aetna returned during that time were incorrect, provider Explanations of Benefits/Explanation of Provider Payments (EOBs/EPPs) are correct. Please ask your clients to retrieve electronic copies of their EOBs in the usual manner. If they’re not able to retrieve electronic EOBs, have the provider contact us. Aetna won’t be reissuing corrected ERA files.

Update 3/15:

Aetna like to let you know Aetna has decided to reissue the affected ERAs. These new 835s will replace any incorrect occurrences of Claim Adjustment Reason Code (CARC) 1, 2 or 3 with CARC 45. Aetna will send an update once we’ve reissued the replacement 835s.

Good Morning,

This alert is to advise that Blue Shield Promise EFT’s from January 1, 2019 to current have not been released to JP Morgan Bank.

We are diligently working to release these transactions today in order to fund providers’ accounts as soon as possible. Going forward, these EFT transactions will be transmitted as scheduled.

We are requesting to partner with you, our Trading Partners, to assist in 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