Conduent EDI Solutions, Inc. EDI Direct Pass Thru Fees

Transcription

1 Conduent EDI Solutions, Inc. EDI Direct Pass Thru Fees Eligibility/Claim Status Payer $ Eligibility/Claim Status Payer $ Aetna Better Health (LA) BCBS of Western New York (Healthnow) Aetna Senior Supplemental 219 BCBS of Wyoming 101 Affinity Health Plan 0.01 AFLAC Alaska 0.07 Allegiance Benefit Plan Management American Family Ins Grp - Medicare Supp & PPO American Retirement Life Ins Co Medicare Supplement AmeriHealth Administrators , BlueChoice HealthPlan South Carolina Blue Cross Independence (Pennsylvania) Blue Cross Northeastern Pennsylvania Blue Shield of Northeastern New York (Healthnow) BMC Health Plan 0.01 Capital District Physicians Health Plan (CDPHP) Careplus Health Plan AmeriHealth Caritas Pennsylvania 0.10 Automated Benefit Services Caresource Ohio 0.00 Central Reserve Life Ins Co Medicare Supplement Auxiant Colonial Penn Life BCBS of Arkansas Colorado Access BCBS of Central New York Community Care of Oklahoma 23 BCBS of Iowa 0.00 BCBS of Michigan Institutional Community HealthFirst Medicare Advantage Continental General Ins Co Medicare Supplement BCBS of Michigan Professional 0.06 NA Denver Health Medical Plan BCBS of Mississippi 160, 266 Freedom Blue 109 BCBS of New York (Empire) Referrals 84 Geisinger Health Plan BCBS of North Dakota 100 Geisinger Health Plan Gold BCBS of Rhode Island 20 Great American Life Insurance Co Medicare Supp 123 BCBS of South Dakota (Wellmark) Health Alliance Medical Plans BCBS of The Rochester Area (NY) 63 Health Partners of Philadelphia BCBS of Utica-Watertown (NY) 64 Health Plan of San Mateo BCBS of West Virginia 65 Healthcare Solutions Group 89 Page 1 of 3 Updated 8/20/2018

2 Conduent EDI Solutions, Inc. EDI Direct Pass Thru Fees Eligibility/Claim Status Payer $ Eligibility/Claim Status Payer $ Healthcomp Administrators , 275 Kansas Healthsmart Benefit Solutions 276 Maryland 51 Independence Administrators Michigan Pending Eligibility 52 Inland Empire Health Michigan MICHILD 53 Jackson Memorial Hospital Health Plan Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Mid-Atlantic States Kaiser Foundation Health Plan of the Northwest NA NA Minnesota Mississippi Montana 25 Nevada 92, , , , 182,292 Kaiser Permanente of Georgia 225 New Hampshire Kaiser Permanente of Northern California Kaiser Permanente of Southern California New Mexico 25 New York Referrals 183, Lovelace Health Plan 24 North Carolina Loyal American Life Insurance Co Medicare Supp Maricopa Care Advantage (Arizona) , North Dakota Oklahoma Maricopa Health Plan (Arizona) 35 South Dakota 55 Arizona NA Tenncare / Tennessee , 150, 302 California (Medi-Cal) Texas Colorado Texas, LTC Connecticut , 207 Vermont 56 Delaware Washington District of Columbia , 190 Wisconsin Florida Georgia Wisconsin Chronic Disease Program Wisconsin Well Woman Program , 152, 200, , 153, 201 Hawaii , 191 Wyoming , 195 Iowa , 154,157 Medicare Y Mucho Mas (INMEDIATA Health Group) 228 Page 2 of 3 Updated 8/20/2018

3 Conduent EDI Solutions, Inc. EDI Direct Pass Thru Fees Eligibility/Claim Status Payer $ Eligibility/Claim Status Payer $ MercyCare Health Plan (WI) SPJST Medicare Supplement 120 Mississippi State Employees And Teachers Health Plan 26 Tricare for Life 248 Molina Healthcare of Illinois Today s Option 211 Molina Healthcare of Michigan Tufts Health Plan Molina Healthcare of New Mexico 180 UMR (Wausau) 110 Molina Healthcare of Texas United Healthcare of River Valley 14 Neighborhood Health Partnerships Novasys Health NA 68 United Teacher Assoc Ins Co Medicare Supplement University Physicians Care Advantage (Arizona) Partnership Health Plan of CA VA Healthcare PHCS Savility Payers 69 Viva Health 251 Phoenix Health Plan 27 Web-TPA, Inc. 117 Preferred Medicare Choice (INMEDIATA Health GRP) Wells Fargo (Acordia National) 197 Providence Health Plan 31 Provident American Life & Health Ins Co Medicare Supp 121 Qualchoice QuikTrip Corporation 114 Rocky Mountain Health Plan 13 S and S Healthcare Strategies San Francisco Health Plan San Joaquin Health Plan Schaller Anderson Mercy Care Select Health SC 142 Senior Care Action Network (SCAN HMO) Senior Dimensions Soundpath Health Page 3 of 3 Updated 8/20/2018

4 /18/ /18/2008 Carefirst /18/ /18/ /18/ /18/ /13/ All payers with no pass thru fee have been removed from this list 3/13/2008 Carefirst Federal Employee /26/2008 Added payer /26/2008 Added payer /7/ /7/ /7/ /7/ Removed from list 7/8/ Removed from list 7/8/2008 Removed Alabama Removed Florida /10/2008 Idaho Removed from list 7/18/2008 Missouri /2/2008 BCBS of Iowa /2/ /2/2008 BCBS of Rhode Island BCBS of South Dakota (Wellmark) /2/2008 CarePlus Health Plan /2/2008 Community Care of Oklahoma /2/2008 Lovelace Health Plan /2/ /2/2008 Maricopa Integrated Health System Molina Healthcare of New Mexico /2/2008 Phoenix Health Plan /2/2008 Puerto Rico /2/2008 Texas CHIP 30 N/A New Payer 10/2/ /16/ Removed from list 11/3/2008 Bluegrass Family Heath Providence Health Plan BCBS of Alabama Medicare Part B Page 1 of 13 Updated 8/20/2018

5 Removed from list 11/3/ N/A New Payer 11/3/ N/A New Payer 11/3/2008 Maricopa Integrated Health System Maricopa Care Advantage (Arizona) Maricopa Health Plan (Arizona) 36 N/A New Payer 11/3/2008 BCBS of Tennessee 37 N/A New Payer 3/17/ N/A New Payer 3/17/ N/A New Payer 3/17/ /30/ /30/2009 Central Reserve Insurance Company Wisconsin Chronic Disease Program Wisconsin Well Woman Program Amerihealth Administrators Independence Administrators /30/2009 Minnesota /30/2009 Acordia National Mohawk/Hickory Springs /30/2009 BC Independence /30/2009 Bluegrass Family Heath /30/2009 Avmed Health Plans /30/2009 BCBS of Louisiana /30/2009 Government Employees Hospital Assoc (GEHA) /30/2009 Hawaii /30/2009 Maine /30/2009 Maryland /30/ /30/ /30/ /30/2009 Michigan Pending Elig Michigan MI CHILD North Dakota South Dakota /30/2009 Vermont 57 N/A New Payer 4/14/ N/A New Payer 4/14/2009 Continental General Insurance Company Fidelis Care New York Page 2 of 13 Updated 8/20/2018

6 59 N/A New Payer 5/5/ N/A New Payer 5/5/ Removed from list 5/26/2009 Recall Systems Boon-Chapman Benefit Admin Recall Systems Corporate Benefit Service BCBS of New York Empire WellPoint Anthem 62 N/A New Payer 5/26/2009 BCBS Central New York 63 N/A New Payer 5/26/2009 BCBS of the Rochester Area (NY) 64 N/A New Payer 5/26/2009 BCBS of Utica- Watertown (NY) 65 N/A New Payer 5/26/2009 BCBS of West Virginia 66 N/A New Payer 5/26/2009 HeatlhSpring 67 N/A New Payer 5/26/2009 Mercy Health Care Plan 68 N/A New Payer 5/26/2009 NovaSys Health 69 N/A New Payer 5/26/2009 PHCS Savility Payers 70 N/A New Payer 5/26/2009 Virginia Premier Health Plan 71 N/A New Payer 5/26/2009 VIVA Health 72 N/A New Payer 6/11/2009 BCBS of Kansas City 73 0 Removed from list 7/10/2009 Pass thru fee changes are effective 8/1/ Removed from list 75 0 Removed from list 76 0 Removed from list Removed from list 79 0 Removed from list /1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 Virginia Premier Health Plan BCBS of Alabama Blue Shield Washington (Regence) Arkansas Connecticut Delaware Massachusetts North Carolina Texas AmeriHealth Administrators AmeriHealth Mercy Health Plan Page 3 of 13 Updated 8/20/2018

7 N/A New Payer 8/31/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 8/1/2009 BCBS of New York (Empire)- Referrals BCBS of South Carolina Blue Cross Independence (Pennsylvania) Capital District Physicians Health Plan (CDPHP) Healthcare Solutions Group Independence Administrators MetLife Dental Family Minnesota Nevada Neighborhood Health Partnership New York Referrals PacifiCare of Arizona (HMO) PacifiCare of Colorado (HMO) Virginia Premier Health Plan BCBS of North Dakota 101 N/A New Payer 8/31/2009 BCBS of Wyoming 102 N/A New Payer 8/31/2009 Oregon Removed from list 9/3/ Removed from list 12/1/2009 Peach State Health Plan Virginia Premier Health Plan Removed from list 12/10/2009 BCBS of Kansas City Removed from list 12/10/2009 BCBS of Louisiana Removed from list 12/10/2009 BCBS of South Carolina Removed from list 12/10/2009 Oklahoma 109 N/A New Payer 2/8/2010 Freedom Blue 110 N/A New Payer 2/8/2010 UMR (WAUSAU) /8/2010 Preferred One /8/2010 Nevada Page 4 of 13 Updated 8/20/2018

8 113 N/A New Payer 3/23/ N/A New Payer 5/4/ N/A New Payer /21/ N/A New Payer 7/9/ N/A New Payer 7/28/ Removed from list 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/ N/A New Payer 9/28/2010 BlueChoice Healthplan South Carolina QuikTrip Corporation BCBS of Michigan Institutional Asuris Northwest Health, WEB-TPA, Inc., Texas CHIP, Payer ID United Teacher Assoc Ins Co Medicare ID SPJST Medicare ID Provident American Life & Health Ins Co Medicare ID Loyal American Life Insurance Co Medicare ID Great American Life Insurance Co Medicare ID Great American Life Assurance Co Medicare ID CSA Fraternal Live Medicare ID Continental General Ins Co Medicare ID Central Reserve Life Ins Co Medicare ID Page 5 of 13 Updated 8/20/2018

9 128 N/A New Payer 9/28/ Removed from list 12/6/ /14/ Removed from list 1/14/2011 American Retirement Life Ins Co Medicare ID BCBS of Mississippi, American Family Ins Group Medicare Supp, Asuris Northwest Health, Removed from list 1/14/2011 AvMed Health Plans, AVMED Removed from list 1/14/2011 BCBS of Tennessee, Removed from list 1/14/2011 HealthSpring, Payer ID Removed from list 1/14/ Removed from list 1/14/ Removed from list 1/14/ Removed from list 1/14/ Removed from list 1/14/ Removed from list 1/14/ Removed from list 1/14/ N/A New Payer 1/14/ N/A New Payer 1/14/ /14/ /14/2011 Recall Systems Boon-Chapman Benefit Admin, Payer ID Recall Systems Corporate Benefit Service, Recall Systems Group & Pension Administrators, Payer ID Recall Systems JP Farley Corporation, Recall Systems Professional Benefits Administrators, Payer ID Recall Systems SRT Administrators, Recall Systems Underwriters Safety & Claims, Select Health SC, UMR, Georgia, Iowa, Payer ID Page 6 of 13 Updated 8/20/2018

10 146 0 Removed from list 1/14/ N/A New Payer /14/ /14/ N/A New Payer /14/ /14/ /14/ /14/ /14/2011 All pass thru fee revisions dated 1/14/2011 are effective for the January billing cycle /7/ /7/2011 All pass thru fee revisions dated 3/7/2011 are effective for the March billing cycle Removed from list 5/2/2011 The above revision is a correction. Careplus was removed from our payer list in September /6/ /6/2011 All pass thru fee revisions dated 7/6/2011 are effective for the July billing cycle /2/ /2/ /2/ /2/2011 Kansas, 1243 Michigan, 947 Minnesota, Oklahoma, 3411 Tennessee, Washington, Wisconsin Chronic Disease Program, Wisconsin Well Woman Program, Iowa, Payer ID Michigan, 947 CarePlus Health Plan, Iowa, Payer ID Michigan, 947 BCBS of Alabama, BCBS of Mississippi, BCBS of New York (Excellus), 2350 Blue Cross Northeastern Pennsylvania, Payer ID Page 7 of 13 Updated 8/20/2018

11 /2/ /2/ /2/ /2/ /2/ /2/ /2/ Removed from list 8/2/ Removed from list 8/2/ /2/ /2/ /2/ /2/ /2/ /2/ Removed from list 8/2/ /2/ /2/2011 Blue Cross of Washington and Alaska (Premera), 2650 Colorado Access, Colorado, Community Health Plan of Washington (CHPW), 2641 Community HealthFirst Medicare Advantage, Denver Health Medical Plan, Payer ID District of Columbia, 2895 Fidelis Care New York, Government Employees Hospital Association (GEHA), Hawaii, 6093 Health Partners of Philadelphia, Payer ID Illinois, 4812 John Hopkins Health Plan, Keystone Mercy Health, 2232 Louisiana, 1164 Mid-Atlantic Medical Services (MAMSI) Inc., MAMSI Mississippi, Molina Healthcare of Washington, Payer ID Page 8 of 13 Updated 8/20/2018

12 /2/2011 Montana /2/ /2/ /2/ /2/ /2/ /2/ /2/2011 Nevada, 2573 New Mexico, Ohio, Payer ID Recall Systems - Mississippi Admin Services, Virginia, West Virginia, Wyoming, 4993 All the pass thru fee revisions dated 8/2/2011 shaded orange are effective for the September billing cycle. All the pass thru fee revisions dated 8/2/2011 shaded green are effective for the October billing cycle /15/ /2/ /2/ /2/ /2/ /2/ /2/2011 Ohio, Payer ID District of Columbia, 2895 Hawaii, 6093 Mississippi, Montana New Mexico, Wyoming, 4993 All the pass thru fee revisions dated 8/15/2011 are corrections to the 8/2/2011 revisions. Revisions replace revisions 184, 169, 172, 179, 181, 183, 188. The 8/15/1011 revisions will be effective for the September 1-30 billing cycle /8/2011 The above fee revision dated 9/8/2011 is effective for the October billing cycle. Florida, Page 9 of 13 Updated 8/20/2018

13 197 NA NA 3/30/2009 See revision 43. Wells Fargo, Payer ID continues to have a pass thru fee of. Acordia National has been removed from Wells Fargo listing. The above revision is a correction. Acordia national was removed on 3/30/ /24/2012 North Carolina, AID21 The above fee revision dated 5/24/2012 is effective for the July 1-31 billing cycle /5/ /5/ /5/2012 Wisconsin, Wisconsin Chronic Disease Program, Wisconsin Well Woman Program, The above fee revisions dated 6/5/2012 are effective for the July 1-31, 2012 billing cycle /1/ /1/ Removed 8/1/2012 The above fee revisions dated 8/1/2012 are effective for the Aug 1-31 billing cycle /1/2013 The above fee revision dated 2/1/2013 is effective for the March 1-31, 2013 billing cycle Removed 7/1/2013 The above fee revision dated 7/1/2013 is effective for the July 1-31, 2013 billing cycle /1/ /1/ /1/2014 The above fee revisions dated 6/1/2014 are effective for the June 1-30, 2014 billing cycle. Geisinger Health Plan, Geisinger Health Plan Gold, American Family Ins Group - Medicare ID Mississippi, Payer is increasing pass thru by $.02. NC, Payer ID AID21. Payer no longer has pass thru fee. Connecticut, Payer ID10067 Ohio, Payer ID Kansas, 1243 Page 10 of 13 Updated 8/20/2018

14 /1/2015 Texas LTC AIDTXLTC /1/2015 ( 3/23/2010) Historical correction Omitted in error. 5/1/2015 ( 8/2/2006) Historical correction Omitted in error. 5/1/2015 ( 8/14/2006) Historical correction - Omitted in error. Today s Option North Carolina AID21 Careplus Health Plan /1/ /22/2015 ( 11/1/2015) 1/17/2016 ( 3/1/2016) 216 NA NA NA 220 NA NA NA 223 NA 224 NA ( ( ( ( ( ( ( ( American Family Ins Grp - Medicare Supp & PPO New Hampshire Connecticut, Payer ID10067 Removed Payer Puerto Rico Blue Cross Independence (Pennsylvania), Kansas, 1243 Aetna Senior Supplemental, Payer ID Alaska, Automated Benefit Services, Kaiser Foundation Health Plan of Colorado, Kaiser Foundation Health Plan of Mid Atlantic States, Payer ID Kaiser Foundation Health Plan of the Northwest, Page 11 of 13 Updated 8/20/2018

15 225 NA 226 NA 227 NA 228 NA 229 NA NA NA NA NA NA ( ( ( ( ( ( 2/24/2016 ( 3/1/2016) Kaiser Permanente of Georgia, Kaiser Permanente of Northern California, Kaiser Permanente of Southern California, Medicare Y Mucho Mas (INMEDIATA Health Group), Payer ID Preferred Medicare Choice (INMEDIATA Health GRP), Payer ID University Physicians Care Advantage (Arizona), Connecticut, Updated missing foot prints and unavailable foot prints got updated with NA. American Family Ins Grp - Medicare Supp & PPO American Retirement Life Ins Co Medicare Supplement New payer added: Allegiance Benefit Plan Management AmeriHealth Administrators BCBS Central New York BCBS of Iowa Blue Cross Northeastern Pennsylvania Careplus Health Plan Caresource Ohio Colorado Access Page 12 of 13 Updated 8/20/2018

16 243 NA NA NA NA /30/ /01/2017 Payer name correction New payer Healthcomp Administrators Independence Administrators Colorado New Payer - S and S Healthcare Strategies New Payer - Soundpath Health New Payer - Tricare for Life North Carolina Washington VIVA Health BCBS of South Dakota Rebranding to Conduent applied Kansas Kaiser Foundation Health Plan of Colorado 06/01/2017 Alaska /01/ /11/ /24/ /24/2017 New Payer Delaware Mercy Health Care Plan Payer deactivated New Payer - BCBS of Western New York (Healthnow) New payer - Blue Shield of Northeastern New York (HealthNow) Added Aetna Better Health (LA) Added Affinity Health Plan Added AFLAC Page 13 of 13 Updated 8/20/2018

17 Alaska Added AmeriHealth Caritas Pennsylvania Removed AmeriHealth Mercy Added Auxiant Removed BCBS of Alabama Added BCBS of Arkansas BCBS of Mississippi Removed BCBS of New York Excellus Removed Blue Cross Premera of Alaska and Washington Added BMC HealthNet Plan Added California (MediCal) Added Colonial Penn Life Removed Community Health Plan of Washington Added Health Alliance Medical Plans Added Health Plan of San Mateo HealthComp Administrators Added HealthSmart Benefit Solutions Removed Idaho Page 14 of 13 Updated 8/20/2018

18 Removed Illinois Added Inland Empire Health Removed John Hopkins Health Plan Removed Keystone Mercy Health Plan Removed Louisiana Loyal American Life Insurance Co Medicare Supplement Removed Maine Added MercyCare Health Plan (WI) Removed Metlife Dental Removed Michigan Added Molina Healthcare of Illinois Added Molina Healthcare of Michigan Added Molina Healthcare of Texas Removed Molina Healthcare of Washington Nevada Removed Ohio Removed Oregon Added Partnership Health Plan of CA Page 15 of 13 Updated 8/20/2018

19 Added Qualchoice Added San Francisco Health Plan Added San Joaquin Health Plan $ The above fee revisions dated 8/20/2018 are effective for the August 1-30, 2018 billing cycle. Added Schaller Anderson Mercy Care Added Senior Care Action Network (SCAN) HMO Added Senior Dimensions Tennessee Added Tufts Associated Health Plan Added VA Healthcare Removed Virginia VIVA Health Removed West Virginia Wisconsin Chronic Disease Program Page 16 of 13 Updated 8/20/2018