WWWREGTAPINFO - PDF document

1 WWW.REGTAP.INFO Overview of February 2
WWW.REGTAP.INFO Overview of February 26, 2016 Maintenance Release��6 WWW.REGTAP.INFO Planned February 26, 2016 UpdatesCMS previously notified issuers of two (2) known DGE server file processing limitations:The medical claim file processing software does not allow the submission of multiple void and replace claims within a single medical claim file.Supplemental Diagnosis odes are not being associated with a medical claim

2 that is replaced with a new Claim ID.Th
that is replaced with a new Claim ID.These items will be corrected with the February 26, 2016 maintenance release.��7 WWW.REGTAP.INFO Multiple Void and Replace Claim Submission Update ubmission of multiple void and replace claims within asingle medical claim file will be accepted after issuersupgrade the EDGE server software on February 26,Changes to the duplicate Claim ID logic, also included in the February 26, 2016 mai

3 ntenance release, may affect the submiss
ntenance release, may affect the submission of void and replace claims depending on how an issuer utilizes Claim IDs. ��8 WWW.REGTAP.INFO Supplemental Diagnosis File Submission Update Supplemental iagnosis odes that reference a Claim ID that has been inactivated and replaced by a new Claim ID will be associated with the replacement claim.The change associated with the duplicate Claim ID will not directly affect processin

4 g of supplemental records. If a claim i
g of supplemental records. If a claim is submitted and accepted and a supplemental record issubmitted and accepted and the Claim ID on the supplemental record is part of an active claim family, the supplemental Diagnosis odes will be included in RA calculations and reporting.Issuers are reminded that the enrollee ID on the claim record and the supplemental Diagnosis record must match. If the enrollee ID is changed, then resubmission of t

5 he claim and/or supplemental record will
he claim and/or supplemental record will be necessary. ��9 WWW.REGTAP.INFO Additional February 26, 2016 Updates During research of the two (2) limitations, it was identified that the source of the problem was related to the duplicate Claim ID logic and the manner in which related claims are assigned to claim families.Duplicate Claim ID logic and claim family associations are present in the pharmacy claim logic, but this

6 issue was limited to the medical claim f
issue was limited to the medical claim file processing logic. No changes will be made to the pharmacy claim logic.Issuers are reminded, however, that pharmacy Claim IDs should be unique, as the duplicate Claim ID logic is applied to pharmacy claim submissions. WWW.REGTAP.INFO Update to Duplicate Claim ID Logic WWW.REGTAP.INFO Creation of a Claim Family A claim family ID is created and assigned when an original claim is submitted and

7 accepted.Subsequent void or replace clai
accepted.Subsequent void or replace claims referencing the original claim are inked to the claim family.For medical claims, the Original Claim ID is used to associate claims in a claim family.For pharmacy claims, the 8 key elements are used to associate claims in a claim family.MEDICAL_CLAIM table (Original and replacement claim with claim family assigned) ORIGINALCLAIM_IDMEDICALCLAIM_ID CLAIM_ FAMILY_IDINACTIVATION_DT CLAIM_ STATUS TRANS

8 ACTION_TCLAIM_PROCESSED_DATETIMENull5555
ACTION_TCLAIM_PROCESSED_DATETIMENull55555C101230T22:10:010 O 06T12:00:0055555C101277777C8440Null1 R 08T14:32:05 WWW.REGTAP.INFO Current Duplicate Claim ID LogicThe existing code bypasses the duplicate Claim ID check when a void or replace is submitted, which can lead to the storage of multiple claims with the same Claim ID in different claim families. ORIGINALCLAIM_IDMEDICALCLAIM_ID CLAIM_ FAMILY_ID INACTIVATION_DT CLAIM_ STATUS

9 TRANSACTION_TYPECLAIM_PROCESSED_DATE_
TRANSACTION_TYPECLAIM_PROCESSED_DATE_TIMECommentsNull55555C1012 30T22:10:01 0 O 06T12:00:00Inactivatedby row 2.55555C101277777C8440 31T21:05:00 0 R 08T14:32:05Inactivatedby row 4.Null99999C5500Null1 O 26T08:01:25ClaimID unique and accepted.77777C8440C844099999C5500Null1 R 26T08:05:01Duplicate check bypassed creating a duplicate Claim ID.When a Claim ID exists under two (2) claim families, the system is unable to determine which cla

10 im to inactivate when a subsequent void
im to inactivate when a subsequent void or replace is submitted. WWW.REGTAP.INFO New Duplicate Claim ID Logic and Inactivation of Duplicate Claim IDs To prevent the storage of duplicate Claim IDs across multiple claim families, the medical claim processing logic will be updated to include a duplicate Claim ID check on all claims including void and replace submissions.In addition, to ensure medical claims are processed correctly going f

11 orward, all stored active claims that ha
orward, all stored active claims that have identical Claim IDs across multiple claim families will be inactivated. WWW.REGTAP.INFO New Duplicate Claim ID Logic and Inactivation of Duplicate Claim IDs Issuers will be provided with a query to identify all icate Claim IDs that currently exist in an active status in the MEDICAL_CLAIM table.CMS recommends issuers run s query by February 1, 2016, or as soon as possible to determine to what e

12 xtent, if any, they will be affected by
xtent, if any, they will be affected by this change. The duplicate im ID bypass will be removed and all duplicate Claim IDs stored in the MEDICAL_CLAIM table will be inactivated with the February 26, 2016 maintenance release. WWW.REGTAP.INFO What s and s ot Changing The February 26, 2016 update to the duplicate Claim ID logic will not prevent issuers from reusing Claim IDs when voiding and replacing a previously submitted claim if the C

13 laim ID is present in only one (1) clai
laim ID is present in only one (1) claim family. When voiding an active claim, the Claim ID and Original Claim ID can be identical.When replacing an active claim, the Claim ID and Original aim ID can be identical. The February 26, 2016 update to the duplicate Claim ID logic will prevent issuers from submitting the same Claim ID if that Claim ID exists on an active or inactive claim in more than one (1) claim family. 16 WWW.REGTAP.INF

14 O Correct Reuse of Claim IDs The exist
O Correct Reuse of Claim IDs The existing EDGE Server Business Rules (ESBR) permit issuers to reuse Claim IDs when voiding or replacing claims in the same claim family. This logic will not change. Issuers do not need to know or include the laim family ID when submitting void or replacement claims.CMS assumes when issuers reuse a Claim ID they are intending to void or replace the last active version of the same Claim ID. ORIGINALCLAIM_I

15 DMEDICALCLAIM_ID CLAIM_ FAMILY_IDINACTIV
DMEDICALCLAIM_ID CLAIM_ FAMILY_IDINACTIVATION_DT CLAIM_ STATUS TRANSACTION_TYPECLAIM_PROCESSED_DATE_TIMENullCLM555TJKFAM12330T22:32:050 O 06T12:00:00CLM555TJKCLM777BNKFAM12330T21:05:000 R 08T14:32:05CLM777BNKCLM999WWOFAM123Null1 R 26T08:05:01NullCLM333LXOFAM99930T20:20:000 O 27T06:02:00CLM333LXOCLM333LXOFAM999Null1 R 27T15:44:15Claim CLM333XLO can be reused and a subsequent void and replace can be submitted to inactivate the current a

16 ctive claim. WWW.REGTAP.INFO Incorrect
ctive claim. WWW.REGTAP.INFO Incorrect Reuse of Claim IDsThe updated logic and ESBR will not permit issuers to reuse laim IDs when voiding or replacing claims across multiple claim families If duplicate Claim IDs are inactivated during the February 26, 2016 maintenance release, issuers cannot reuse those Claim IDs for any reason. Reuse of inactivated duplicate Claim IDs will be rejected. ORIGINALCLAIM_IDMEDICALCLAIM_ID CLAIM_ FAMILY_I

17 D INACTIVATION_DT CLAIM_ STATUS
D INACTIVATION_DT CLAIM_ STATUS TRANSACTION_TYPECLAIM_PROCESSED_DATE_TIMECommentsNull55555C1012 30T22:10:01 0 O 06T12:00:00Inactivatedby row 2.55555C101277777C8440 31T21:05:00 0 R 08T14:32:05Inactivatedby row 4.Null99999C5500 26T23:30:00 0 O 26T08:01:25 Inactivated on 2/26/16. 77777C844099999C5500 26T23:30:01 0 R 26T08:05:01 Inactivated on 2/26/16. Claim 99999C5500 can no longer be submitted. WWW.REGTAP.INFO Evaluate

18 Identified Duplicate Claim IDsIssuers a
Identified Duplicate Claim IDsIssuers are responsible for identification of duplicate Claim IDs using the CMS provided query to evaluate the claims and determine what actions should be taken. ORIGINALCLAIM_IDMEDICALCLAIM_ID CLAIM_ FAMILY_ID INACTIVATION_DT CLAIM_ STATUS TRANSACTION_TYPECLAIM_PROCESSED_DATE_TIMECommentsNull55555C1012 30T22:10:01 0 O 06T12:00:00Inactivatedby row 2.55555C101277777C8440 31T21:05:00 0 R 08T14:32:

19 05Inactivatedby row 4.Null99999C5500Null
05Inactivatedby row 4.Null99999C5500Null1 O 26T08:01:25Null77777C844099999C5500Null1 R 26T08:05:01NullIn this example, an issuer would need to verify if both claims with 99999C5500 should remain active.Issuers can submit a void or replace prior to February 26, 2016 to correct the stored duplicate claims. New claims will not be inactivated if they have unique Claim IDs. WWW.REGTAP.INFO Query to Identify Duplicate Claim IDs Issuers shou

20 ld run the query shown below to identify
ld run the query shown below to identify claims that will be inactivated on February 26, 2016 by Monday, February 1, 2016, to allow sufficient time for research and resolution prior to the maintenance release. Exceptions to the inactivation of duplicate claims will not be permitted. ��20 &#x/MCI; 30;&#x 000;&#x/MCI; 30;&#x 000;SELECT DISTINCT MEDICAL_CLAIM_A.UID, MEDICAL_CLAIM_A.MEDICAL_CLAIM_ID FROM MEDICAL_C

21 LAIM CLAIM_FAMILY_A, MEDICAL_CLAIM CLA
LAIM CLAIM_FAMILY_A, MEDICAL_CLAIM CLAIM_FAMILY_B, MEDICAL_CLAIM MEDICAL_CLAIM_A, MEDICAL_CLAIM MEDICAL_CLAIM_B WHERE MEDICAL_CLAIM_A.UID != MEDICAL_CLAIM_B.UID AND CLAIM_FAMILY_A.MEDICAL_CLAIM_ID=CLAIM_FAMILY_B.MEDICAL_CLAIM_ID ANDMEDICAL_CLAIM_A.CLAIM_FAMILY_ID=CLAIM_FAMILY_A.CLAIM_FAMILY_ID AND MEDICAL_CLAIM_B.CLAIM_FAMILY_ID=CLAIM_FAMILY_B.CLAIM_FAMILY_ID AND MEDICAL_CLAIM_A.INACTIVATION_DT IS NULL AND MEDICAL_CLAIM_B.INACTIV

22 ATION_DT IS NULL; WWW.REGTAP.INFO Additi
ATION_DT IS NULL; WWW.REGTAP.INFO Additional Information Please contact your FM Service Representative atif youhave any questions. The ESBR will be updated to reflect the February26, 2016 mntenance release and is tentativelyscheduled to be published on February 19, 2016. WWW.REGTAP.INFO Upcoming Webinars WWW.REGTAP.INFO Upcoming Webinars Webinar TopicScheduledEvent DateRA QualityMeasures February 2, 201611:30 a.m. – 1:00 p.m. ETPla

23 n ID Updatesuary 9, 201611:30 a.m. –
n ID Updatesuary 9, 201611:30 a.m. – 1:00 p.m. ET WWW.REGTAP.INFO Questions?To submit questions by phone: Dial ‘14’ on your phone’s keypad.Dial‘13’ to exit the phone queue. WWW.REGTAP.INFO Resources WWW.REGTAP.INFO Resources Resource Link/Contact InformationCenter for Consumer Information and Insurance Oversight (CCIIO)http://cms.gov/cciio/ Registration for Technical Assistance Portal (REGTAP)Registr

24 ation Inquiry Tracking and Management Sy
ation Inquiry Tracking and Management System (ITMS)Resource Library Frequently Asked Questions (FAQs) https://www.REGTAP.info/ 26 WWW.REGTAP.INFO Inquiry Tracking and Management System (ITMS) ITMS is available at https://www.regtap.info/ Users can submit questions after the Webinar by selecting “Submit an Inquiry” from My Dashboard. Note: Enter only one (1) question per submission. WWW.REGTAP.INFO FAQ Database on REGTA

25 P FAQ Database is available at https://w
P FAQ Database is available at https://www.regtap.info The FAQ Database allows users to search FAQs by FAQ ID, Keyword/Phrase, Program Area, Primary and Secondary categories, and Publish Date. 28 WWW.REGTAP.INFO Closing Remarks WWW.REGTAP.INFO Agenda Session Guidelines Intended Audience Purpose Overview of February 26, 2016 MaintenanceRelease Update to Duplicate Claim ID Logic Upcoming Webinars Resources Closing Remarks �

26 �2 WWW.REGTAP.INFO PurposeThe
�2 WWW.REGTAP.INFO PurposeThe purpose of this ED serv seion is to provide an overview of the February 26, 2016 maintenance release which includes:Acceptance of multiple void and replace claims within the same fileAssociation of supplemental Diagnosis odes with a medical claim that is replaced with a new Claim Updates to the duplicate Claim ID logic for medical claim submission��5 WWW.REGTAP.INFO Intended Audienc

27 eAmazon and OnPremise External Data Gath
eAmazon and OnPremise External Data Gathering Environment (EDGE) server issuers (Marketplace and NonMarketplace) of plans in states where the U.S. Department of Health & Human Services (HHS) operates the Affordable Care Act (ACA) RA and RI ProgramsThird Party Administrators (TPAs) and Support Vendors��4 WWW.REGTAP.INFO S ession Guidelines This is a-mte wr se. For questions regarding content and the DDC program, please c

28 ontact your Financial Management (FM) Se
ontact your Financial Management (FM) Service Representative directly and copy the Centers for Medicare & Medicaid Services (CMS) Help Desk (CMS_FEPS@cms.hhs.gov).For s rding lics d rration, please ctact the Rrar at () 7-. ��3 January 26, 2016 WWW.REGTAP.INFO Additional February 26, 2016 Updates • uring research of the two (2) limitations, it was identified that the source of the problem was related to the duplica

29 te Claim ID logic and the manner in whic
te Claim ID logic and the manner in which related claims are assigned to claim families. plicate Claim ID logic and claim family associations are present in the pharmacy claim logic, but this issue was limited to the medical claim file processing logic. No changes will be made to the pharmacy claim logic.Issuers are reminded, however, that pharmacy Claim IDs should be unique, as the duplicate Claim ID logic is applied to pharmacy claim su