New York State Medicaid eMedNY News & Issues as
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1. Excessive processing time for DVS requests This issue has been resolved e PA DVS history requests Some PA DVS history prior to 7 21 is not available Issue was resolved e PA DVS Response Activity Work List Not all response types are being populated in the link list Issue was resolved e Third Party Insurance Rejections Some claims submitted through ePaces might be failing MMIS edit 131 Third Date Resolved 8 25 2011 8 4 2011 8 3 2011 8 4 2011 8 4 2011 Party Indicated Other Insurance Amt Not Submitted when the non covered charges are entered Issue was resolved FTP Submitted files from 7 19 7 21 being returned in the directory 8 8 2011 FTP submitters may have noticed that some of their files from 7 19 7 22 were still waiting to be picked up Please contact the eMedNyY Call Center with your User ID for resolution POS Device DVS Printout Missing HCPC POS users were reporting that 7 27 2011 the HCPCs code was not printing on their receipts2. csc com for details If no testing occurs for new transactions claims will reject with a GS99 response Pre Adjudication Edits A7 521 Invalid Adjustment Reason Code eMedNY is returning this pre adjudication edit when it encounters an invalid or expired Claim Adjustment Reason Code CARC in a COB claim or when the prior payer s Adjudication Date is not present for the specific payer The Adjudication Date is required when the prior payer adjudicated the claim in order to verify the validity of the CARCs If you receive an A7 521 please verify the CARCs are valid and that the DTP 573 segment is present for the prior payer Response Files Batch Naming Convention Change Users who send and receive electronic batch transactions will see a new naming convention for response files An extra node was appended to the response file naming convention to distinguish the file type being sent to the user The node will contain 0101 for TA1 0201 For F File which will only be sent if the input file was structurally wrong and had to be rejected 0301 For 999 0401 for 997 0501 for for 277CA 0601 for U277 0701 for a 278 1001 for 271 For example R110725123456 0401 depicts a 997 Response UPDATED 8 25 2011 See Response Files Batch Naming Convention Change 7 25 2011 835 Electronic Remit Files Naming Convention Change The file name for the 835 Remit file has changed The dash in the naming convention has been remove
3. New York State Medicaid eMedNY News amp Issues as of 08 25 2011 The purpose of eMedNY News amp Issues is to share eMedNY related information and identify system issues relevant to our NY Medicaid provider community The document includes Important Announcements New eMedNY Issues and Active eMedNY Issues and will be updated as issues are corrected and or new issues are identified eMedNY News amp Issues will be posted on the eMedNY HIPAA Support page of www emedny org Please visit this site periodically for updates For questions about the information in this document please consult with your technical staff or send an email to emednyhipaasupport csc com Contents NEW Announcements NEW eMedNyY Issues Active eMedNY Announcements Active eMedNY Issues Resolved Issues vV Announcements and Issues resolved more than 6 months ago are archived here NEW Announcements 835 Electronic Remit Files Naming Convention Change A change in the naming convention of the 835 820 Electronic Remit was necessary to accommodate larger numbers of response files The 2 digit node has been expanded to 4 digits For an FTP user R110821123456 1774 835 0000 For an eXchange User R110821123456 1774 835 0000 x12 Response Files Batch Naming Convention Change UPDATE A change in the naming convention was necessary to accommodate large numbers of outbound response files Extra digits have been added to make this node a 6 digit f
4. d Users with scripted downloads particularly the FTP user community may want to revisit their scripts to accommodate this change UPDATED 8 25 2011 See 835 Electronic Remit Files Naming Convention Change 6 24 2011 Claim Balancing for 4010 Many calls have been generated to the eMedNY Call Center regarding claim balancing for 4010 transactions eMedNY is not enforcing new claim balancing requirements for 4010 claims transactions Strict balancing is being enforced for 5010 6 22 2011 ANSI ASC X12N HIPAA Technical Report Type 3 TR3 Implementation Guides The Companion Guides offered on www emedny org only contain information that is specific to submitting a transaction to NYS Medicaid Trading partners need to utilize the ANSI ASC X12 TR3 s in conjunction with the eMedNY Companion guides It is the responsibility of the Trading Partner to manage their software programming and systems needs 6 17 2011 X12 End of File Characters Because the eMedNY processing environment is accepting only streaming data formatted files end of file characters embedded in the data will cause a file to reject End of file characters such as carriage returns or line feeds are no longer allowed 6 16 2011 POS Software Update July 21 2011 In the event of any unforeseen system issues with the new software providers may use alternative methods to verify client eligibility ARU ePACES and 270 Batch Inquiry Please visit www emedny org for details about alt
5. ebruary Medicaid Update referred providers to U47 U contact the Plan to determine coverage Some of the plans are not giving out information and are telling the providers to call CSC DOH is addressing the issue UPDATE 8 25 2011 This issue was addressed to the Plans by the DOH The plans should now be able to determine plan coverage PAPET Pre Adjudication Edits Rate Code Not on File Invalid Rate Codes are now a pre adjudication edit reported back in the U277 4010 or 277CA 5010 An invalid rate code is a rate code that does not exist in the system If a rate code is valid but is not on the providers rate file the claim will not reject but will be denied on the remittance as Rate Code not on Rate File The eMedNY system was reading rate codes submitted in various formats Depending on the rate code and how it is entered in relationship to the decimal the claim might be rejected The reject occurs if the last digit of the rate code is not included such as 3170 is entered as 31 7 PALPE NCPDP Field 420 DK Submission Clarification Claims submitted with a 1 character Submission Clarification Code i e 1 instead of 01 were rejected in error PIJPJE Dashboard Blank 835 Files 835 files displayed on the Dashboard appeared to be blank A fix is forthcoming However users should not deviate from the process for downloading their 835 Electronic Remits they used before the Dashboard became available reJ Ok EPACES e
6. ernative access methods for verifying client eligibility 6 13 2011 ETIN Submitter Information With the implementation of ASC X12 version of 5010 a Certified Electronic Transmitter Identification Number ETIN is required for all electronic submissions into the eMedNY System eMedNY has a new requirement for 270 and 278 transactions When the submitter is a Provider ETIN in the GSO2 must be certified to the provider NPI MMIS submitted When the Submitter is not a provider such as a service bureau the ETIN in GSO2 must be certified to the 8 digit MMIS Submitter ID Refer to the Trading Partner Information Companion Guide for more detailed information Active eMedNY Issues Last Updated 7 21 2011 Eligibility Responses no longer include the COUNTY CODE eMedNY is NEW no longer returning the County Code for the client when eligibility is UPDATE checked The County Code is not part of the 5010 HIPAA Standard for the 271 This is causing a variety of issues for some trading partners DOH is considering alternatives UPDATE 8 11 2011 Estimated date to 8 11 2011 reestablish a county code returned in an MSG segment is 9 15 2011 As soon as the layout of the MSG segment is known it will be posted Resolved Issues Original Issue Date Paps Eligibility Eligibility responses for Clients with a Managed Care plan eMedNY no longer returns the scope of benefits for the Managed Care NEW plan An article in the F
7. ield The first two digits denote the file type The next 4 digits represent the Sequence number of the file 010001 TA1 020001 F File which will only be sent if the input file was structurally wrong and had to be rejected 030001 999 040001 997 050001 277CA 060001 U277 070001 278 100001 271 For example R110725123456 040023 depicts a 997 Response with a sequence number of 0023 EPACES There have been many changes made to the ePACES application There are many user guides and quick reference to assist in navigating these changes The Self Help section on www emedny org provides this documentation Dashboard On July 21 2011 the eMedNY Dashboard was introduced to assist Trading Partners with tracking the status of batch submissions This window was designed to show the User what stage of processing a batch is in The Dashboard can be accessed on the home page on www emedny org Trading Partners are encouraged to review the User Manual To access the User manual click on the link on the eMedNY home page that says Dashboard Information Pre Adjudication Edits Effective July 21 2011 eMedNY Front End Pre adjudication Edits for front end error conditions are returned in outbound responses to claim submissions 277CA for 5010 submissions and U277 for 4010 Claims that have passed all Pre adjudication edits and do not have errors indicated will be reported on a future remittance advice Claims
8. rejected by the front end process will not be reported in a Remittance Advice These claims are ONLY identified in the U277 or 277CA Itis important for all trading partners to download and process all response files returned by eMedNY A list of Pre adjudication edits and associated claim status codes is posted on www emedny org in the eMedNY HIPAA Support section Click on 5010 Crosswalks New eMedNyY Issues Active eMedNY Announcements 7 28 2011 7 28 2011 7 28 2011 7 28 2011 7 25 2011 NCPDP D 0 5 1 Total Amount Paid Field 509 F9 NCPDP transaction will now have the 509 F9 Field returned This Field contains the final reimbursement amount Prior to July 21 2011 trading partners may have been using other fields to calculate an estimated amount The fields used for this calculation have not changed and your calculation will be the same but a more accurate amount will now be available in the 509 F9 field NCPDP D 0 Reject 39 Missing Invalid Diagnosis Since July 21 2011 many D O claims have returned this rejection code With D O the Diagnosis code must have the implied decimal point CPU Real Time Vendors Testing CPU Real Time vendors are required to test and certify with eMedNY before sending any new transaction types E mail letters were sent to these vendors to set up testing If you have not tested please work with Provider Relations via the email sent or contact emednyhipaasupport
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