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Are your billers and claims specialists receiving Department email notifications? Oftentimes, only the credentialing specialist who originally enrolled the provider is subscribed to our mailing list. To make sure the appropriate person within your practice is getting the information they need, please invite them to sign up here. Under Email Lists, select “00 – All Provider Emails to receive: 1) a weekly Last Week in Review newsletter, which includes Hot Topics, Featured Provider Resources, and status updates on Known Issues; 2) a monthly notification when the Provider Bulletin is published; and 3) occasional general announcements relevant for all providers. Select your provider type to subscribe to communications specific to your provider type, including status updates on Known Issues. Also, make sure to keep contact information up to date in the Provider Web Portal.
Many providers have had questions about how to reconcile claim adjustments reflected on their RAs. Based on provider feedback, the Financial Transactions page of the RA has been updated to provide additional payment and recoupment information. These changes were implemented on January 9, 2019, and will appear on RAs for the January 11, 2019, financial cycle.
A detailed summary of the RA updates is available under the All Providers drop-down section of this page, titled Remittance Advice (RA) Update to Help Providers Reconcile Payment Remittances 1-9-2019.
The following resources have been updated to reflect the latest RA updates:
Effective January 9, 2019, providers may see an increase in the number of Remittance Advices (RAs) received each week dependent upon the financial activity occurring during that period. Any payment holds, Accounts Receivable (AR) recoveries and third-party garnishments may be reported on additional RA (separate from the standard RA posted each Monday). For example, if a provider sends in a check and it is applied to the AR or refunded, that activity may be reported on an additional RA. An RA will not be generated if there is no financial activity during that period.
Current claim payments will still be paid on a weekly cycle and RAs will still be posted each Monday. ERA X12 835s will also be posted each Monday. All trading partners/submitters were notified of these changes in the following communication: ERA X12 835 Reports Schedule Change.
RAs will not be distributed on state holidays and instead will be distributed the following business day. Upcoming holidays are noted on the Provider Contacts web page.
Refer to the table on page 8 of the Provider Web Portal Quick Guide - Verifying Member Eligibility (including Managed Care Assignment Details and Benefit Plan Information) and Co-Pay, available on the Quick Guides and Webinars web page, for billing instructions based on member benefit plan.
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Office of Community Living Communications