02/24/2017 – Aetna Claims Issues
You may have received an email from CentralReach tech support regarding discrepancies of Aetna 835s (ERAs). What exactly does this mean?
It has come to our attention that when posting payments electronically in CentralReach the payment may sometimes post to the incorrect line item. For example, if both the EOB and the ERA state that $20 should be paid for a service on 6/17/16 when users click reconcile, it may post this payment to the wrong date of service of 6/18/16. Consider the example below.
Normally, when a biller clicks on Reconcile checked, each amount in the Paid column would apply the correct payment on that date of service for that code. From the screenshot below, this means that $36.80 would be applied to billing entry from the date of service on June 7th with the service code 368T, another $36.80 applied to the entry from June 2nd with 0364T, etc.
However, users may find that if they click on Reconcile Checked without individually auditing each timesheet, the system may be applying the payments to the wrong date of service and/or code. So clicking on the first entry below from June 7th with the service code of 365T:
…may take them to the billing entry from June 2nd with service code 365T as shown below:
When CentralReach sends electronic claims to Aetna via Office Ally, each billing entry gets its own unique code; for example, an entry from 6/17 may have the code 123456 with a charge of $20, and an entry from 6/18 may have the code 654321 with a charge of $50. When Aetna sends these entries back into CentralReach, sometimes, the codes may come back scrambled. So, instead of coming back as:
Payment to 123456: 20.00 for 6/17
Payment to 654321: 50.00 for 6/18
They may be coming back as:
Payment to 654321: 20.00 for 6/17
Payment to 123456: 50.00 for 6/18
To prevent discrepancies in the reconciliation of Aetna claims, we recommend that billers audit each line entry by clicking on each one from the Reconciliation screen, then applying the payments manually as if they were paper EOBS, rather than clicking Reconcile checked to prevent payments being posted to the incorrect billing entries. Please note that this is not happening with every Aetna ERAs, so if users click on each entry from the Reconciliation page and are taken to the correct billing entry, they can still reconcile electronically.
We are currently working with Aetna to resolve their EDI compliance discrepancies. If you have any questions, please open a support ticket and one of our agents will advise further.
The second scenario involves Aetna splitting the payments and claim lines and creating multiple payments that then record multiple times.
In the above scenario, there was only one line submitted for 9/1, but Aetna internally split the claim, this can be seen here, as well as, on the ERA, txt file.
9/02/15 – New Features to Help Migrate ICD-9 to ICD-10
CentralReach is dedicated to helping you effectively manage your practice in an ever-changing healthcare industry. That’s why we are releasing additional features to help you prepare for a significant change in ICD coding.
ICD-10, the tenth revision of the World Health Organization’s International Classification of Diseases (ICD) coding system, is set to replace ICD-9 in all U.S. hospital and clinical healthcare settings on October 1, 2015. Any entity covered by HIPAA will need to comply with ICD-10 in order to obtain reimbursement for care, including clearinghouses and billing services.
To help you prepare for ICD-10 changes, CentralReach is adding new features to our Contacts, Authorizations, Billing, Timesheets, and Claims Manager modules that make editing diagnosis codes even easier. Each diagnosis field within these modules can be changed to ICD-10 selections by searching for it. Detailed information about this updated functionality can be found in our help section over the new few days.
Please be sure you are in contact with your payers to discuss how ICD-10 impacts your claims and reimbursement processes; each insurance company has unique strategies and nuances for managing this transition.
Thank you for your support as we work through these industry changes together.