JUNE NEWSLETTER

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Validator 5.9.0 Patch Now Available—NHIC Medicare submitters strongly encouraged to update!

Stephens & Associates has released another patch to the Validator direct electronic claims program. This rather quick follow-up to version 5.8.0 has been released as a direct result of NHIC Medicare’s new password policy. When they decided to require more complex passwords, and enforce a password history (a policy that went into effect April 18th) we decided to change the scripting (auto-send) portion of our program so that our end-users could continue to enjoy the automation of having their claim files sent for them with no user interaction necessary. When your passwords expired, our program was redesigned to automatically increment the number in those passwords by one, so that you would not have to re-enter a new password every day.

So what happened? In addition to the questionable decision NHIC made to make everyone’s passwords expire on April 18th, 2005, NHIC also did not allow any advanced testing of the CABBS changes they implemented. As a result, we were unable to thoroughly test this automatic incrementing feature. While the program was able to properly change all passwords ending with a 9 back to a zero, it created an invalid new password for any passwords ending in 0 through 8. For example, if your password was “passwo#0”, instead of making a new password of “passwo#1”, the new password would come out as “passwo# 1”. The CABBS system that NHIC uses stops reading the new password at the space, so saw the new password as too short. End-users would then find themselves in the frustrating situation of not being able to log into Medicare at all, and Validator technicians had to call Medicare to have them reset each of your passwords so that we could get everyone back up and running. Since S&A has over 300 clients submitting to NHIC, and since NHIC had everyone’s passwords expire at the same time, this made for some very busy days at S&A.

The good news is that the change that was needed was a small one, and that it now has had the opportunity to be tested with NHIC, and works well.

Who should get this update? This update is only needed for anyone submitting to NHIC Medicare using our Validator, or for those clients using Validator for AltaPoint. No other significant changes have taken place.

Downloading Carrier Reports

If you have been a client of ours for any length of time, there is little doubt that you have heard our “importance of downloading reports” speech. Almost every carrier that you can submit to with the Validator offers some sort of report file back in response to the claims that you have sent them. These reports offer invaluable information about your claims, such as whether the claims were accepted or rejected, and why. We here at Stephens & Associates have gone out of our way to develop a program which not only sends your claim files, but also allows you to download your report files, read them, store them, and print them with as little effort as possible. We have built into most carriers the “auto-send” feature which automatically retrieves reports for you, the “Reports and Mail” screen which keeps track of all of your read and unread reports, and lately, the “Validator Notepad” program, which automatically formats difficult to read reports such as 997 reports and 277 reports, and allows you to view, edit and store these reports easily. Still, with all of these tools at our client’s disposal, we still run into problems making sure that our clients are getting all of their reports. Below is a list of the common problems we encounter, and how we usually go about troubleshooting those issues.

1. I have not received any reports
Usually if a client has not received ANY reports, they are simply not asking for them. When using the built in terminal screen to transmit claims, there are several options for how you can connect to the carrier. If a carrier offers reports, and the auto-send feature is capable of automatically retrieving those reports, you will be able to choose the button with the red and blue arrow at the top of the screen which is for transmitting claims AND receiving mail in the same phone call. So often, our clients are only choosing the button with the red arrow, which is for transmitting claims only. This is easy to rectify, as you can, at any time, go into the program and choose the blue arrow button to retrieve all mail automatically

2. I am not getting all of my reports
The question we need to ask here is, which reports are you not getting? If you are getting only a certain type, or certain types of reports then the auto-send feature may not be programmed to download all reports types, especially if your carrier requires a different prompt for each report type (Palmetto Medicare is like this). Fortunately, the Validator also allows you to log in manually and choose the appropriate files to be downloaded. Your carrier will have the instructions for how to do this.

3. I do not understand my reports
If you are using Validator version 5.8.0 or above, you are likely using “Validator Notepad” to view your reports. Validator Notepad has been designed specifically to make reports easier to understand and read, as it automatically translates standardized reports, and makes sure the reports you do get are readable. If the report you are viewing are nothing but garbage characters and start with the letters “PK”, then it is likely a zipped (compressed) file, and you need to ask your carrier not to compress the files. Finally, if the report is technically readable, but does not seem to make sense, the carrier that sent you the report should be your first stop. You can find their contact numbers under settings\carrier setup options from within the Validator program.

THIN’s Got A Brand New BAG

For those of you who are submitting claims to The Health Information Network (THIN), you may have noticed a new edit coming back on your reports with the error code “BAG” or “BAH”. These edits were implemented on 5/16/05 and are only affecting those of our clients who are submitting as single doc offices (non-groups). For these providers, THIN is now requiring the use of the Taxonomy code on all inbound claims in order to assure that the claims do not get rejected when being forwarded to any of THIN’s “trading partners”. The Taxonomy code, also known as the provider specialty code, is a unique 10 digit code which identifies the specialty of the provider. You can find your taxonomy code by going to www.wpc-edi.com. While Stephens & Associates is disputing this decision with THIN and the CMS Administrative Simplification Enforcement Team, prior to any resolution to this issue, we are recommending to all of our clients that they put a taxonomy code in their practice management program to avoid problems in the interim. If you have Lytec, this goes in Lists|Providers|Insurance IDs, in insurance code 19. If you have AltaPoint, it goes in File|Employees|Electronic Claims in the Specialty field.