Validator 5.8.0 is now available!!!
Validator 5.8.0 is here. After many
months of feedback and hard work, we have come out with yet another
series of improvements to our Validator program, and we are offering
these to our existing customers in the form of a FREE update. In
addition to handling changes in NHIC Medicare's password policy
which take effect April 11th, you can expect the following improvements
over 5.7.6:
New and improved report viewer
Ability to rename your claim files
Ability to Zip and Encrypt claim files
Reports and Mail now includes a "Size" Column
Automatically detect and rename\relocate ERA files
Plus Many more…..
While this update is not required,
it is recommended that you download and install this update, especially
if you utilize any of our NHIC carriers.
Medicare Box 11 Rejections!
We have been getting
inundated with calls from clients who have been having their claims
rejected by NHIC Medicare for missing information. These clients
all have the commonality of being told that box 11 on their HCFA
forms needs to be filled in with the word “NONE” if
there is no secondary insurance, or if there is no secondary insurance
group number. This field usually contains the secondary, or “other” insured
group or policy number.
While CMS does occasionally change the rules on how they accept claims, it
is MUCH easier for them to change the way they are accepting paper claims
than with the HIPAA compliant ANSI electronic claims format. With every single
one of the clients who have called us regarding this error, the rejected
claims HAD been printed and submitted on paper. There is NO CHANGE NECCESARY
to your Validator system to be compliant with the box 11 issue. This is yet
another reason why electronic claims are superior to paper ones.
How to Tell if the
Claim is on Paper or Electronic:
During the process of
investigating these rejections for our clients, we have discovered
a great trick for telling how National Heritage Insurance Company
(the Medicare Intermediary for California, Maine, Massachusetts,
New Hampshire and Vermont) received the claim. Each claim is assigned
a unique “ICN” number.
In Southern CA, if that “ICN” number starts with 11,
18, or 19, the claim was received electronically. For Northern
CA, the ICN number for an electronic claim will begin with 02,
09 or 10. If the ICN number starts with anything else, the claim
was received on paper.
ERA, Lytec 2005, and the
Validator
What is ERA?
ERA, or Electronic Remittance
Advice is an electronic version of the paper EOB’s that your
office normally receives from the carrier. Just like the paper
EOB, the electronic remittance advice file contains claim specific
payment and adjustment information, which can be used to post payments
into your practice management system.
Does Validator
work with ERA?
The easy answer is “yes,” because
the Validator can download and display any reports that your carrier
provides to you during the normal claims transmission process.
The REAL question that should be asked is “Does the Validator
automatically post my payments into my practice management system”.
This feature, which is known as “Auto-posting” is a
heavily touted feature of the new Lytec 2005 program. While the
Validator does not automatically post the payments into your practice’s
data files, it will work hand in hand with Lytec 2005 to do so.
How does Validator and Lytec 2005
work with ERA files?
While NDCHealth would
love for you to believe that you must use their clearinghouse in
order to use the new ERA feature in Lytec, since the format is
fairly standard, you can use it with ANY electronic payer who will
provide you an ERA file. When you download your reports and mail
from the carriers, and go to view them, the Validator will automatically
detect if a file is an ERA file and will prompt you to save the
ERA file in a location, and with an extension that Lytec is expecting.
Then you can go into Lytec and use the ERA feature to process and
autopost that file.
What you need:
Validator 5.8.0 or
above – This executable is available as a download from our
download page, and contains the changes which allow us to automatically
recognize and re-route the ERA files.
Lytec 2005 – The ERA feature only works with the most current version
of NDCLytec, which is currently Lytec 2005.
An Electronic Form File designed for use with Lytec
2005 – We had to make some changes in the
way we were formatting your claim files so that the ERA files
coming back from the various payers would look just like the
ones NDCLytec is expecting. If you are not using this form file,
you will get an error when trying to run Lytec’s ERA AutoPosting
wizard telling you “unable to post (billing not found)”.
What about my Practice Management
System?
While there are plans to support
ERA AutoPosting for AltaPoint, users of older versions of Lytec
should consider upgrading their version of Lytec in order to take
advantage of this feature.
