PayerAnnouncements


 

See also our HeW News & Events web page.
See also our Eligibility and Claim Status Alerts web page.

Date

Payer

Announcement

11/15/2017

Tricare North & South

Tricare North and Tricare South are Becoming Tricare East

TRICARE North and South regions will become TRICARE East and will service the following states: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island Arsenal area only), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area only), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding the El Paso area), Vermont, Virginia, West Virginia and Wisconsin

Humana Military was awarded the new TRICARE East Region with an effective date of January 1, 2018. Wisconsin Physicians Services (WPS) will be the new fiscal intermediary/claims processor for TRICARE in the new East Region.

TRICARE North/South Claims with dates of service prior to January 1, 2018, will continue to be processed by PGBA with Payer ID 38520 until April 30, 2018. 

TRICARE East EDI claims for dates of service on and after January 1, 2018 will be processed by WPS under Payer ID TREST.

Action Required:

All providers who currently send claims to Tricare North and/or Tricare South must enroll for Tricare East, prior to January 1, 2018.  If enrollments are not completed prior to January 1, 2018, you may experience delays or claim rejections by WPS.

WPS requires that all electronic providers/groups sign, and have on file, a Trading Partner Claims Agreement (“Agreement”) prior to submission of electronic claims. All providers that will submit EDI claims directly to WPS will need to complete a self-registration process that includes an initial registration and the necessary request forms and business agreement(s).

HeW RCM Clients please complete the following tasks, using the attached instructions.  If you are not a HeW RCM Client please contact HeWSupport@availity.com for enrollment assistance.

  • Go to WPSIC website at https://www.wpsic.com/edi/edi-forms.shtml
  • Complete the EDI - Electronic Claims Submission (837) Provider EDI Enrollment for Claims
  • Complete the ERA - Electronic Remittance Advice (835) Provider ERA Enrollment for ERA.

Once EDI Self Registration has been completed, you will receive an email with the enrollment agreement that needs to be completed. This agreement will have a unique Tracking ID assigned to it.

  • The agreement must be signed by the provider listed on the registration.
  • The signed agreement form must be saved using the unique Tracking ID as the file name.

Upload the signed agreement to the WPS Manager File Transfer (MFT) system at https://edi.wpsic.com/Transfer/cfcc/login/login.jsp

Since Provider EDI Self-Registration does not require an account, the following User Name and Password should be used to access the Managed File Transfer (MFT) agreement upload system when uploading the agreement - EDIEnroll#17

  • Use this value for both the User Name and Password.

Once uploaded, you will receive a series of emails that provides status of what needs to be done next (if anything). WPS staff will also receive emails to review and to advise you if a step has been approved, rejected or needs to be reworked.

Questions: Please contact edienrollment@availity.com or call our customer service center at (877) 927-8000.

07/11/2017

Michigan Medicaid

Attention ALL Michigan Medicaid Providers,

Please be advised: As part of the transition from the current State of Michigan (SOM) financial system, Michigan Administrative Information Network (MAIN), to Statewide Integrated Governmental Management Application (SIGMA) there will be a delay in payment and Remittance Advices (RA), i.e. HIPAA Electronic 835 transactions & paper, from the Michigan Department of Health and Human Services (MDHHS).

Pay cycle 40 payments (pay date 10/5/2017) and RA’s will be delayed and pushed into pay cycle 41 (pay date 10/12/2017). Please be mindful as there will be no payments and RA’s generated on 10/5/2017; pay cycles 40 and 41 payments and RA’s will be combined on pay date 10/12/2017.

In the event issues may arise given the transition from MAIN to SIGMA, MDHHS will immediately notify providers.  

SIGMA Key Dates: 

  • July 31, 2017: Claim your account and verify information in SIGMA VSS 
  • October 2, 2017: C&PE no longer available for update
  • October 5, 2017: No Payments and RA’s
  • October 12, 2017: Combined 40 & 41 pay cycles

Benefits Include: 

  • Manage account information, view invoice and payment information for checks and EFTs 24 hours a day, 7 days a week!
  • Improved communication through automated e-mails 
  • Unique Vendor/Customer ID improves privacy 
  • Provides more detailed spending analysis and robust report options

For more information on SIGMA’s major improvements, visit Michigan.gov/SIGMAVSS 

Additional SIGMA resources and Provider information can be found at Michigan.gov/MedicaidProviders

For questions please contact the SIGMA Vendor Customer Support Center (VCSC) at SIGMA-Vendor@Michigan.gov

05/24/2017

Keystone Connect

Keystone Connect - Payer ID 77050

Effective, January 9, 2017, Keystone Connect has canceled the Professional and Institutional claims service with Change Healthcare.  The Payer has indicated that this plan was termed in October 2015 and the timeframe for filing claims has expired.

Claims received will be dropped to paper and mailed to the payer.

02/13/2017

BCBS (IL, MT, NM, OK, TX)

Maintenance Notification for
Eligibility & Benefits and Claim Status Transactions

Blue Cross and Blue Shield of IL, MT, NM, OK and TX will be performing maintenance on 02/19/2017 from 7:00 AM until 3:30PM Central.  Please refrain from sending Eligibility & Benefits (HIPAA 270) and Claim Status (HIPAA 276) inquiries during this time.  We apologize for any inconvenience.

This notification affects the following Plan(s):

  • BCBSIL
  • BCBSMT
  • BCBSNM
  • BCBSOK
  • BCBSTX

02/01/2017

Indiana Medicaid

Indiana Medicaid - New Processing System

Indiana Medicaid is moving to a new processing system.  HeW will be holidng claims that are submitted to us between 02/08/2017 - 02/12/2017.  The claim files will be sent to Indiana Medicaid on 02/13/2017.