Several agencies have received notifications that they have submitted recent claims that after May 1, 2013 will be denied because of problems with the physician submitted on the claim compared to the PECOS file. Below are the changes to the software that have been made to help agencies make corrections.
1) In Doctors, when you post the PECOS file we will warn you if the NPI number could not be found in PECOS or when the physician name in HHC3000 does not match the PECOS file. Beside the Post button there is a new button labeled “Results.” This button will list the active physicians where the name did not match or that the NPI number could not be found.
2) We have changed physician listing to include an option to print only physicians where the names do not match the PECOS file. You already had the option to print physicians where the NPI was not found in PECOS.
3) CMS has been telling agencies to just review their remittance files and look for remarks code N272. Sometime ago CMS started putting remittance claims remarks in the ANSI 835 remittances but we were not aware of the change. We have changed the printout under Electronic Remittances to display claim remarks code. We suggest printing recent remittance files (without posting of course) to see if you had any claims with remarks code N272.
4) We have removed the physician middle initial from the ANSI 5010 electronic file. The PECOS file does not contain a middle initial and we also had information stating that the middle initial should be removed.
5) In Billing where you print ANSI files we made changes to how 835 remittance files display on the right had side of the report. This will also show remittance remarks such as the N272 comment. Printing the file under Electronic Remittances is still an easier method to find the remarks.