July 3, 2008

Denied Claims

At the time of the system problem, if you had an appeal pending for a claim that had previously been denied, the impacts to you would be different than those where the claim denied and is being reprocess for payment. Providers who expected to receive payment for the appealed services instead received a refund requests. Individual contacts are being made to those impacted providers to explain the actions that need to be taken. Once again, we apologize for the inconvenience this has caused.

Attention Part B EDI Customers:

Due to a technical problem at the Enterprise Data Center (EDC), the delivery of the MCS Edit reports and the ANSI ASC X12N 835 Electronic Remittance Advice(ERA) dated July 2, 2008 are delayed and not yet available. A follow-up listserv will be sent when the reports and ERAs are available. We apologize for any inconvenience.

July 2, 2008

Denied Claims (Update)

As of July 2, 2008 we have reprocessed a third of the claims denied in error.  We anticipate that all impacted claims will be completed within the next two weeks.  We will continue to provide you periodic updates. 

June 18, 2008

Denied Claims (Update)

On June 12, 2008, Highmark Medicare Services Inc. erroneously denied claims and adjustments with message B7 - This provider was not certified/eligible to be paid for this procedure/service on this date of service. This message will be shown on the standard provider remittance (SPR) of the claim and/or adjustment. The adjustment activity on previously paid services automatically generated a demand (refund) request through the Healthcare integrated General Ledger Accounting System (HIGLAS).

After reviewing several options to correct this situation, Highmark Medicare Services Inc. has decided to mail the demand (refund) letters. The impacted providers need to repay the amount indicated in the demand (refund) letter to Medicare. If you wish to request immediate offset, please call 1-888-291-2623.

All impacted claims and adjustments will be re-adjusted to pay as appropriate under a separate payment. We understand this is an inconvenience to the provider community and apologize, however due to claims processing limitations, this is the most efficient way to resolve this issue.

June 16, 2008

ATTENTION! Denied Claims

We have identified a system problem that caused claims processed last Thursday night (June 12) to deny for non certified/eligibility for the dates of service on the claim. We are currently researching this issue and will post more information as it becomes known.

You are not required to take any actions at this time.

June 9, 2008

MCS Edit Report Delayed for Pennsylvania Part B Customers - FINAL UPDATE

Attention Pennsylvania EDI Customers: The MCS Edit Reports for any claims received between 4 pm on June 2, 2008 and 4 pm on June 3, 2008 are now available for retrieval. We apologize for any inconvenience this delay may have caused.

June 5, 2008

MCS Edit Report Delayed for Pennsylvania Part B Customers - UPDATE

Due to a repeated system issue, the MCS Edit Reports for any claims that were received between 4 pm on June 2, 2008 and 4 pm on June 3, 2008, are not yet available for retrieval. They should be available for retrieval tomorrow, June 6, 2008. This is a report delay only, please do NOT resubmit the claim files. Thank you for your patience.

June 4, 2008

MCS Edit Report Delayed for Pennsylvania Part B Customers

Attention Pennsylvania EDI Customers:Due to system issues, the MCS Edit Reports for retrieval today, June 4, 2008, are not available. The MCS Edit Reports for any claims that were received between 4 PM on June 2, 2008 and 4 PM on June 3, 2008, should be available for retrieval tomorrow, June 5, 2008. We apologize for any inconvenience this delay may cause.

May 6, 2008

Attention: Pennsylvania Part B EDI Customers

The PA Part B MCS Edit Reports for claim files submitted yesterday, May 05, 2008, are currently not available. We are in the process of resolving the issue and we will notify you when the reports are available. We apologize for any inconvenience. 

April 29, 2008

Limited ERA Files Unavailable - UPDATED 04/28/08

Attention Part B Providers:

Due to system issues, a limited number of Electronic Remittance Advice (ERA) files were not available for retrieval on 04/08/2008, 04/09/2008 and 04/10/2008.

All files have now been recreated. The majority of these files were recreated on 04/15/2008. Any outstanding files were recreated on 04/28/2008. We apologize for the delay and any inconvenience this may have caused. Thank you for your patience.

April 17, 2008

Limited ERA Files Unavailable - Update - REVISED

Attention Part B Providers:

Due to system issues, a limited number of Electronic Remittance Advice (ERA) files were not available for retrieval on 04/08/2008, 04/09/2008 and 04/10/2008.

The majority of these files have been recreated and are available for retrieval today, 04/15/2008. A few ERA files are still in the process of being recreated. Once the remaining files are available, another update will be provided. We apologize for any inconvenience.

April 9, 2008

Limited ERA Files Unavailable

Attention Part B Providers: Due to system issues, a limited number of Electronic Remittance Advice (ERA) files were not available for retrieval on 04/08/2008 and 04/09/2008.  We are in the process of identifying those impacted and working with our system maintainers to correct this issue as soon as possible.  Resolution details will be provided once available.  We apologize for any inconvenience.

April 2, 2008

ERA files Delayed for Pennsylvania Providers - PA Part B Only

The Electronic Remittance Advice (ERA) files dated April 1, 2008 for Part B Pennsylvania Providers are currently not available.  We are researching the delay and we will provide more details as soon as they are available.  We apologize for any inconvenience.

March 19, 2008

PA Part B MCS Edit Reports Delayed

The PA Part B MCS Edit Reports for claim files submitted 03/18/2008 are currently not available. We are in the process of resolving the issue, and we will notify you when the reports are available. We apologize for any inconvenience.

February 15, 2008

Attention EDI Billers! M012 and M013 Rejections - UPDATE

December 27, 2007

IVR Outage - UPDATE

Due to a Pennsylvania Part B System batch cycle problems at the Enterprise Data Center, the PA Part B IVR was not fully functioning today, December 27, 2007. The problem has been corrected and as of 12:55pm, the IVR should now be fully functional.  We apologize for any inconvenience.

IVR Outage

Due to a Pennsylvania Part B System batch cycle problems at the Enterprise Data Center, the PA Part B IVR is not fully functioning today, December 27, 2007.  The anticipated up time for full PA Part B IVR availability is 1:00pm eastern time.  We will update this alert as more information becomes available.  We apologize for any inconvenience.

October 19, 2007

Incorrect Denials

Highmark Medicare Services has identified that claims and adjustment claims containing a beneficiary name and Health Insurance Claim (HIC) number mismatch were incorrectly denied from 10/01/07 through 10/12/07. This denial was the result of an incorrect setup for an edit that generates for this mismatch error. Highmark Medicare Services has corrected the edit error and are currently working to identify and adjust any incorrectly processed claims. As more information is identified, we will update this alert. We apologize for any inconvenience this issue has caused.

August 10, 2007

Part B IVR Outage

Due to extended system maintenance, the Part B IVR will not be available starting at 4:30 on 8/10 through the remainder of the weekend. We apologize for any inconvenience this has caused. Normal operations will resume at 7:00 AM on Monday 8/13.

July 30, 2007

Immediate Offset Requests

If you called Highmark Medicare Services Immediate Offset line (1-888-291-2623) requesting immediate offset, there was trouble with the line. We lost all messages from Wednesday, July 25, 2007 through 9:00 am the morning of Friday, July 27, 2007. The line is now working. If you left a message for immediate offset on Wednesday through 9:00 am Friday, we are asking that you fax those requests into our office. We are making three fax lines available - (717) 302-3823, (717) 302-3807 and (717) 302-4273. Thank you. We apologize for any inconvenience this matter may have caused.

June 28, 2007

Stratus Telecommunication Server Unavailability

Due to system maintenance, Stratus will be unavailable for all electronic transactions, including claim submission and report retrieval, on Sunday, July 1, 2007, from 6:00 PM through 7:00 PM. We apologize for the inconvenience.