ICD-10: It’s time to test with Anthem

ICD-10: It’s time to test with Anthem

Anthem has started acceptance testing for providers who are EDI direct-submitters. We have chosen TIBCO Validator® as our primary testing tool that offers unlimited testing of your EDI HIPAA transactions. This self-guided, web-based processing application is equipped to test file formats and edits as they pertain to ICD-10. If you are not a direct submitter, you will need to partner with your claims submission vendor (clearinghouse, billing company, etc.) to test with us.

To get started, visit the “Free On-Line HIPAA Validation Testing” section on our Anthem EDI webpage, where you can find links to registration information and the guidelines for using the tool.

For more updates on ICD-10, visit the ICD-10 Updates webpage at www.anthem.com>Providers (enter state)>ICD-10 Updates.


IN, KY, OH: Changes to EFT 

Within the next few months, providers will see enhancements to EFT, including a new ability to search online by Nasco check, Nasco EFT remittance, and Nasco EFT number. In addition, there will be a change in search parameters: You will be able to hunt for remittances within a new 7 day range for remittances issued up to 2 years prior to current date.

As a result of the new functionality, there also will be minor screen display changes:

  • The page title for ‘Check Date Range:’ will be changed to ‘Check/EFT Date Range:’
  • The column title for ‘Check Date’ changed to ‘Check/EFT Date’.
  • The column title for ‘Check Number’ changed to ‘Check/EFT Number’.
  • The column title for ‘Check Amount’ changed to ‘Check/EFT Amount’.

Note: If you are not set up for EFT and would like to be, you may sign up utilizing the CAQH EFT enrollment tool, which simplifies EFT registration and allows providers to enroll and update practice information electronically. A link is available via the Availity® Web Portal and the Anthem EDI website. After completing the online EFT enrollment forms, enrollees will receive a confirmation that the enrollment request has been submitted. The CAQH website and CAQH EFT enrollment tool provide additional information about the benefits of EFT and the registration process.


5 Ways to Help Ensure Medical Claims Can Be Processed

ensure medical claims can be processedHealthcare providers are facing more challenges than ever when it comes to making sure medical claims are paid. Medical offices are not only implementing healthcare reform provisions, payers are constantly updating policies for reimbursement and pre-certification, along with making coding changes.

Add to that the October 1st, 2014, ICD-10 deadline. With ICD-10 increasing the number of CM and PCS codes from ICD-9’s 17,000 to a formidable 141,000, it’s enough to make any medical office staff member a bit nervous.

The challenge?
Potentially lower reimbursements.

It’s simple. If the correct code is not submitted for the service provided, the claim cannot be processed and it won’t be paid accordingly. But with more than nine times as many codes coming, mistakes are bound to increase – at least temporarily.

The plan?
Stay on top of changes to ensure medical claims can be processed.

Need to ease the transition to ICD-10? Here are 5 things to check to ensure medical claims can be processed and paid as promptly as possible:

1. Check payer’s websites monthly for updates

It is important that office staff check payer’s websites monthly for updates. Many times a claim isn’t processed or paid correctly due to a change in a policy by a payer. Some offices send payer updates, but many do not.

2. Check alpha and numeric coding

Coders often confuse the number “0” (zero) with the letter “O” and the number “1” (one) with the letter “l.” Good news: The letters O and I excluded in the ICD-10 system to avoid confusion with the numbers 0 and 1.

3. Check diagnosis and procedure codes needed to process the claim

It is imperative that both the diagnosis and the procedure are coded. Another must: Check accuracy and ensure complete coding of records and medical records. Functional errors, including records that coded incompletely or codes associated with the wrong medical test, will result in an unprocessed claim.

4. Check medical records

With the implementation of ICD-10, it is important to check specifics found in medical records to ensure prompt claims processing. For example, the coder must specify specific type of chest pains, which may mean looking at the information in the medical record that differentiates them from atypical pains.

5. Check codebooks for accuracy and don’t rely completely on coding software

To cut down on errors, practice management software prepared for the ICD-10 transition may be implemented. This can be a time- and sanity-saving means of moving into ICD-10. However, it’s important for coders to continue referencing codebooks and not develop an over-reliance on coding software.

Taking time to check a few simple areas can help ensure that medical claims can be processed quickly and paid as promptly as possible. As medical providers prepare for moving to ICD-10, taking time to check now can result in a smoother transition. Cornerstone Alliance serves Allen, Auglaize, Hancock, Hardin, Logan, Mercer, Paulding, Putnam, Shelby and Van Wert counties in Ohio. Please contact us if we can be of service to you!