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Managed Data Systems
EDI Update Bulletin!
Vol. 2 No. 10		October 2000 Edition

Holiday schedule 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 our 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

Payer changes

The following payers will be live, effective October 4th. 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 Alias number

OSCHNER Health Plans (" 909044") (H0702)

Lifeguard ("1759002") (H0701)

University Health Plan Medicaid (" 30551") (H0691)

University Health Plan (" 30552") (H0692)

Mahoning Trumbull Ins Ohio (" 30553") (H0693)

Youngstown Welfare Fund (" 30554") (H0694)

Molina Healthcare WA (" 30555") (H0695)

Liberty Mutual (" 30556") (H0696)

American LifeCare (" 30557") (H0697)

Comm Care Healthcare OK (" 30558") (H0698)

Tri County Health Fund OH (" 30559") (H0699)

Local 33 Youngstown Welfare (" 30560") (H0700)

New hospital payer Payer number Alias number

Georgia Health Plus PPO ("5009214") (U0253)

Healthease ("5009215") (U0254)

Staywell Hlth Wellcare Hos ("5009216") (U0255)

University Hlth Plan GA Hos ("5009217") (U0256)

Goodyear Tire and Rubber Hos ("5009218") (U0257)

Lake Forest Manage Care Hos ("5009219") (U0258)

Coventry Hlth Care IN Hos ("5009220") (U0259)

Coventry Hlth Care IA Hos ("5009221") (U0260)

Coventry Hlth Care KC Hos ("5009222") (U0261)

Coventry Hlth Wichita Hos ("5009223") (U0262)

Coventry Hlth Care LA Hos ("5009224") (U0263)

Coventry Hlth Care NE Hos ("5009225") (U0264)

Hlth Options Connect Hos ("5009226") (U0265)

Medplan PPO Hos ("5009227") (U0266)

Willis Admin Svc Corp Hos ("5009228") (U0267)

Health One Alliance PPO Hos ("5009229") (U0268)

First Integrated Health Hos ("5009230") (U0269)

Alexian Brothers Hos ("5009231") (U0270)

Cape Health Plan Hos ("5009232") (U0271)

St Therese Phys Assoc Hos ("5009233") (U0272)

Hinsdale Phys Hlthcare Hos ("5009234") (U0273)

Payer number deletions Payer number Alias number

Mississippi Select Health Care (" 30387") (H0579)

Payer number re-routing Payer number Alias number

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Additional program update reminders from last month

UnitedHealthcare payer numbers being deleted, effective October 4

On October 4, all claims to the following UnitedHealthcare payers must be sent to one single, common Payer ID number—2009000. Old Payer ID numbers (see below) will be deleted and will no longer be recognized by the claims processing program. To avoid rejections send all claims for these payers to Payer ID number—2009000.

United Healthcare Of Georgia (“ 509100”)

PHP Of Sc (“ 509101”)

Western Ohio Healthcare Corp (“ 509102”)

Ocean State PHP Fall River Ma (“ 509104”)

UHC Of North Carolina (“ 509106”)

Share Hlthplan Of Illinois (“ 509109”)

Share Hlthplan Of Il Capitated (“ 509111”)

UHC Of The Midlands Inc Choice (“ 509120”)

UHC Of The Midlands Inc Select (“ 509121”)

PHP Of Ohio Clinicare (“ 509122”)

PHP Of Ohio Benefit Systems (“ 509123”)

Ocean State PHP Commercial (“ 509126”)

Ocean State PHP Mcare Mcaid (“ 509127”)

PHP Of St Louis (“ 509128”)

PHP Of St Louis Carus (“ 509129”)

New York Hospitals Care Networ (“ 509131”)

United Hlthcare Of Utah (“ 509133”)

Metrahealth Admin For Met Life (“ 509134”)

Metrahealth (“ 509135”)

United Healthcare Of Florida (“ 509136”)

United Healthcare Of Mid Atlan (“ 509137”)

United Healthcare Of The South (“ 509138”)

United Healthcare Of Kentucky (“ 509139”)

United Healthcare Of Colorado (“ 509140”)

United Healthcare Of North Ca (“ 509141”)

United Healthcare Of South Ca (“ 509142”)

UHC Of South Florida (“ 509143”)

UHC South Birmingham Al (“ 509144”)

UHC South Nashville Tn (“ 509145”)

UHC Louisiana (“ 509146”)

UHC South Jackson Ms (“ 509147”)

UHC South Little Rock Ar (“ 509148”)

Evercare (“ 509149”)

United Health And Life (“ 509150”)

United Healthcare Of Arizona (“ 509151”)

United Healthcare Of New York (“ 509152”)

United Healthcare Upstate Ny (“ 509153”)

UHC Health Plans Puerto Rico (“ 509154”)

United Healthcare Of Texas (“ 509155”)

United Healthcare Of Virginia (“ 509156”)

Total Care Management (“ 509157”)

Payer number deletions

Opticare Eye Health Network—(“ 30428”) Alias (H0630)

WPS Champus—(“ 73000”) Alias (H0019)

Sunstar Health Plan Inc—(“ 30332”) Alias (H0497)

Payer number re-routing

Sagamore Health Network—(“ 31017”) Alias (H0080) will be re-routed to Sagamore Health Networks (“1979001”) (MUSSGMR).

Electronic Funds Transfer (EFT)

If you are using Electronic Funds Transfer (EFT), and your bank merges or is bought out by another institution, you need to notify your Medicare carrier so your records can be updated. When a merger or acquisition occurs, whether you’re made aware of it or not, your account and routing numbers are subject to change. In most situations, out of courtesy, the new institution will continue making the deposits to the correct account, and they will notify the source of the EFT that the routing information being used is now incorrect. However, you cannot count on this happening. So, if you are notified that your financial institution is being merged with, or acquired by another institution, please contact the institution and ask if your routing and/or account number has been changed. If they have, contact your Medicare carrier and request an EFT Agreement Form. Complete and sign the form, then return it ASAP to ensure that payments to your account will be made without delay. (NOTE: Be sure to notify any company, including Per-Se, with whom you have any automatic transfer of funds arrangement.)

NHIC future carrier of ALL California Medicare Part B claims

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 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.