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Managed Data Systems
EDI Update Bulletin!
Vol. 2 No. 11		November 2000 Edition

Payer changes

The following payers will be live, effective November 1st. These payers will be added automatically to your payer database. Be sure to match the spelling of each payer with those produced in your billing system. If you scan on the payer number instead of the payer name, those numbers are also included for your convenience.

New medical payer Payer number

GREAT LAKES (“ 30451”)

PACIFICARE TX AND OK (“ 909044”)

ACCESS MED (TENNCARE) (“ 592001”)

XANTUS (TENNCARE) (“ 592002”)

BLUE SHIELD NV (“1790000”)

MEDICAID NV (“1792000”)

BLUE SHIELD NH (“2020000”)

INTERGROUP (“1769014”)

KANSAS CITY LIFE INS (“ 30561”)

APA PARTNERS (“ 30562”)

GROUP HEALTH COOPERATIVE WI (“ 30563”)

AVERA HEALTH PLANS (“ 30564”)

GROUP HEALTH COOP ENCOUNTER (“ 30565”)

PREMIER HEALTH NETWORK (“ 30566”)

HEALTHSOURCE MASSACHUSETTS (“ 30567”)

New hospital payer Payer number

AVERA HEALTH PLANS HOS (“5009951”)

GROUP HEALTH COOPERATIVE HOS (“5009952”)

GROUP HEALTH COOP ENCOUNT HOS (“5009953”)

HEALTH FUND LOCAL396 HOS (“5009954”)

LIBERTY MUTUAL HOS (“5009955”)

KANSAS CITY LIFE INS HOS (“5009956”)

HEREIU WELFARE PENSION HOS (“5009957”)

MEMPHIS MANAGED CARE HOS (“5009958”)

PREMIER HEALTH NETWORK HOS (“5009959”)

MEMPHIS MANAGED CARE/TLC HOS (“5009960”)

MEDIPHIS MANAGED CARE/TLC (“5009961”)

PREMIER HEALTH NETWORK HOS (“5009962”)

Payer number deletions Payer number

BOON CHAPMAN ADMINISTRATRS INC (“ 30345”)

LIBERTY MUTUAL (“ 30556”)

OLYMPIC HEALTH MANAGEMENT SYST (“ 30395”)

MARYLAND PHYSICIANS CARE (“1769009”)

MASSACHUSETTS MUTUAL (“ 30132”)

MASS MUTUAL UNICARE LIFE AND H (“ 30132”)

UNICARE LIFE AND HEALTH INS C (“ 30132”)

ADVANTAGE HEALTH CARE (“1419005”)

EYE ASSOCIATES NETWORK (“1419010”)

MISSION MEDICAL GROUP ENCOUNTE (“1419012”)

PROCARE MEDICAL GROUP ENCOUNTE (“1419014”)

BLUE CROSS NM (“5090000”)

Payer number re-routing Payer number Alias number

ALLEN MEDICAL CLAIMS ADMIN (“1419006”) to (“ 30455”)

EGS EMPLOYEE GROUP SERVICES (“1419009”) to (“ 30460”)

SELECT BENEFIT ADMINISTRATORS (“1419013”) to (“ 30454”)

CNA INSURANCE (“ 30153”) to (“ 909045”)

HEALTH PLAN SERVICES INC (“ 30327”) to (“ 909046”)

NORTHWESTERN NATL LIFE (“ 30155”) to (“ 909047”)

NORTH TEXAS HEALTHCARE (“ 30305”) to (“ 909048”)

ACCORDIA NATIONAL (“ 30268”) to (“ 909049”)

Additional program update reminders from last month

Payer number re-routing Old New

Coventry Health Care Carolinas (" 30491") (" 30465")

Coventry Health Care DE (" 30492") (" 30467")

Coventry Health Care GA (" 30490") (" 30466")

Primary Physician Care (" 30449") (" 30374")

General American Life Assr Co (" 30013") (" 909040")

Principal Financial Grp (" 30041") (" 909036")

Prudential Ins (" 30044") (" 909034")

Oxford Life CT (" 30112") (" 909039")

Health Alliance Plan Of MI (" 30130") (" 909037")

Fortis Ins (" 30163") (" 909043")

Guardian Life Ins Co Amer (" 30168") (" 909041")

Mamsi Ins (" 30237") (" 909042")

Alliance PPO Ins (" 31032") (" 909038")

Blue Shield CA (" 30113") (" 909035")

Holiday schedule reminder: While our offices will be closed on certain days during the upcoming holidays, you will be able to transmit claims whenever it is convenient for you. Our holiday schedule is as follows:

Holidays	Days MDS offices will be closed	Claims received on holidays will be transmitted after 5:00 PM CST	Normal business hours and client support will resume
Thanksgiving	Thursday & Friday, November 23-24	Monday, November 27	Monday, November 27
Christmas	Friday & Monday, December 22, 25	Tuesday, December 26	Tuesday, December 26
New Years Day	Monday, January 1	Tuesday, January 2	Tuesday, January 2

NHIC future carrier of ALL California Medicare Part B claims

Don’t forget, effective December 1, 2000, NHIC will be the Medicare Part B carrier for ALL of California. This means that ALL electronic Medicare B claims, whether for Northern or Southern California, will be submitted to NHIC in Chico. Currently, Transamerica Occidental Life Insurance Company (TOLIC) is the Medicare contractor in Southern California. The transition from TOLIC to NHIC is scheduled to take place on December 1, 2000. NHIC promises to keep everyone updated with any changes to Medicare and/or EDI processes via Vendor Newsletters, Medicare Special Notices, direct mailings, messages on the provider remittances, Submitter Newsletters, and the NHIC web site <http://www.medicarenhic.com>. NOTE: Refer to the October 2000 issue of NewsWire for a list of changes that will affect submitters who are currently sending to TOLIC (payno = “ 611000” ).

THANKSGIVING GREETINGS

We appreciate the many opportunities we’ve had to serve you.

Thanks for placing your confidence in us.

We value your continued loyalty and commit ourselves to serving you well.

PASS IT ALONG This publication contains important information for all MDS users. Please share it with everyone in your organization who is involved with the transmission of claims. Contact us if you want an individual copy mailed to anyone.

NHIC promises to keep everyone updated with any changes to Medicare and/or EDI processes via Vendor Newsletters, Medicare Special Notices, direct mailings, messages on the providers remittances, Submitter Newsletters, and the NHIC web site (www.medicarenhic.com).

NHIC held Vendor Meetings during the week of September 11 to discuss the changes listed below. If you did not attend any of these meetings, please pay very close attention to all upcoming notices.

Following are some of the changes that will affect submitters who are currently sending to TOLIC (payno = “ 611000”):

1. Medicare claims will be processed by NHIC instead of TOLIC, as of December 1, 2000.

2. After December 1, 2000, the TOLIC Bulletin Board System will no longer be available. The Carrier Bulletin Board System (CABBS) will be used.

3. The CABBS edits will be different than those currently seen on TOLIC’s BBS.

4. All of the edits for Northern and Southern California will be made consistent, therefore the Pre-processing / Pre-pass error messages seen on the acknowledgement reports from TOLIC will be different.

5. The telephone number used to transmit electronic transactions will change as of December 1, 2000.

6. All electronic submitters will initially be set up to receive acknowledgement reports on paper. If you prefer to get them online in the CABBS mailbox, NHIC must be notified. Prior to December 1, NHIC in Northern California must be notified. After December 1, you need to notify NHIC EDI Department in Southern California.

7. The on-line acknowledgement reports currently provided on the TOLIC BBS will change.

8. Magnetic tapes will no longer be accepted.

9. Multiple PKZipped claims files, as well as eligibility inquiry files, may be sent via Y and Z modem protocols ONLY.

10. Electronic Remittance files will no longer be available as executable files (.exe). PKZipped format containing multiple files is not available. If the submitter enrolls for zipped output, ALL output files will be zipped (transmission logs, 997 reports, ERA, acknowledgement reports, eligibility responses).

11. A Transmission Log will be returned every time a claims submission is sent. This log will be in a different format than what Transamerica returns, so scripts that are being used may be affected.

12. All claims transmitted before 5:00 PM will be assigned a transmission ID number, and that same day’s Julian date, when it is logged. Claims transmitted after 5:00 PM will be assigned a transmission ID number, but will be held for the next business day’s Julian date assignment as receipt.

13. EDI enrollment forms for Southern California providers will continue to be processed in Southern California.

14. Some required and conditional fields within the NSF and ANSI formats will be different.

15. The CABBS system will be available for TESTING as of September 7. All TOLIC submitters will be defaulted to test status on the CABBS database. Therefore, all electronic submitters must test between September 7 and December 1 to become familiar with the CABBS and CABBS edits.

16. In order for the submitters to have all output files available and to have a smooth transition, there will be a cut-over period shortly before December 1, 2000.