May 2014 Troubleshooting Presentation by: Kurt Kubishke, Eldorado Rod Wall, Teamsters Troubleshooting

May 2014Troubleshooting

Troubleshooting

Presentation by: Kurt Kubishke, Eldorado Rod Wall, Teamsters

Troubleshooting


Agenda

Welcome to our Troubleshooting and ‘did you know’ Session

Status codes for Billing and Claims

Most often reported problems

Red Screens

Useful Utilities

Release Testing and Schedule

How and when to report issues


Claims / Billing Status codes


Most often reported problems

• Claims

• Premium Billing

• Check Processing

• Red screens


Claims

Claims not pricing or paying correctly, what should I check?

Contracts

C4H, HIAA, RVRBS FairHealth schedules

CES edits - Group Master and/or benefit plan/network

level

Fee schedules - provider/network & benefit

plan default settings

EDI Pricing

Episode Records

Adjudication logic

BAD benefit code – check benefit code cross

reference

Benefit plan settings - Benefit or DGN

Exceptions or Exclusions


Exception codes

How do I know what a certain exception code means?

– Online Customer Support has a full table of exception types and codes used within HP4

http://support.eldocomp.com/support/HP4_Help/index.htm


Claim exceptions – 770 Table

The 770 Table within HP4 also has a list of exceptions


Admin and Billing Troubleshooting



Why isn’t the system billing my rates correctly?

1. Review the effective date of the rate table.2. Review the effective date of employee and what the DEP

Coverage type is.3. Calculate a test rating from billing options attached to the

employee to see if this displays any errors.4. Look at Dep Coverage type attached to the employee

eligibility screen. Based on the Dep coverage, reflect back to rate table to make sure rates are entered for that Dep coverage type.

5. Check to see if the rate guarantees are filled out in error



1. You receive an excluded premiums report when running your monthly billing .

Cause/Solution: You only get this when the system can not print that product on a bill, therefore this product is probably not coded on your billing format. If this product is coded on your format, make sure the product is not broker specific coded and you have the correct broker attached to this product’s rate table.

2. When a group terminates and then wants to come back what should I do?

Cause/Solution: Use the group reinstatement program. However we recommend that you give the group a new group code as if the group never was in system. Because this can cause billing issues and this groups eligibility may not be the same. If the same group code needs to be used for billing history purposes user will have to make any corrections manually. (applies to limited lapse in coverage)

3. What if the wrong rates were given for the group and I already billed for the month? Cause/Solution: Use the group wide adjustment program



If you are looking at a report and realize the system is double, tripling, your billed lives.Cause/Solution: Look to see what code you have in your Admin Configuration in the Billed lives Calculated by field. If you have this set to N=Employee, D=triples billed lives, E=doubles billed lives, A=Employee plus the actual # of dependents attached to the

employee master.



Misc. Fees are not printing on my billing format. Cause/Solution: Is your billing format coded to print misc. fees. If so do you have the misc. fees attached at the group level.

(Group master, (/)backslash, (O)ptions, (B)illing, (M)isc Fees)



• I have an incorrect balance forward showing on last month’s billing statement.



• I made a payment for $759.00 for the April premiums on 4/1/2013. Why did system not pick it up on the 5/1/2013 bill?



• If you look at that month’s billing summary screen check to see if you spanned the dates to include payments from and thru to pick up the last payment made.



• As you can see, the 5/1/2013 bill was run to include payments from 1/1/2000 thru 3/31/2013, so the payment made on 4/1/2013 would not be picked up.

• The dates were not spanned out enough to include this payment, and therefore, a balance forward was created. All you would have to do now is, re-extract, print/post the 5/1/2013 statement (as long as no payments were post for May premium) and span the include payment date to be the same day you are creating the extract, to ensure all payments made will be picked up.



• The Billing & Payment Evaluation Report is a helpful report to run, for balance forwards, and other billing/payment issues.

Billing & Payment Evaluation Report criteria

(M9bilpmt)

*** If you see asterisks on this report, these represent errors, either system caused or user caused, and you should contact an ECI customer service rep for review***


Check Run Process


Check Run Process


Check Run Process


Check Run Process

• Avoid problems by always reviewing the current batch audit report and daily check register reports before posting.


Check Run Process


End of Day – check run process

Incorrect benefit plan errors during check run process?

X9fixpln will correct these claims.


Red Screens

Purpose of Lesson

To learn how to read “Red Screen” error messages and how to avoid some common causes

What is the error trying to tell us?

What can be fixed by a re-index?

How to resolve a network-related errors

Understanding index files & breakage demonstration


Red screens, cont.

Cheat sheet for common red screens:


Red screens, cont.

Cheat sheet for red screens

• Return code: DB/c error code and description – single most important element

• Release: Version of HEALTHpac

• Program name: Program that triggered error

• File name: File or program in question

• File key: Key to record in question

• Label: Internal program label being called

• Error: Key to type of problem

• Program info: Program compile information


When to re-index system files

• Attempt to read past file end

• Write or insert of duplicate key

• Invalid index file

• Attempt to read a record that does not exist or is deleted


Corrupted data errors requiring ECI assistance

• Invalid file type

• Record too long

• Record too short

• Wrong record length


Network-Related Errors

• Open mode conflict

• Unable to open

• Unable to close

• Unable to read

• Unable to lock file

• Error during write

• Device or print file name is null or invalid

• Program or file not found


Program errors (most of the time)

• Array pointer reference out of bounds

• Return stack overflow

• External label not found

• Read with null key and invalid position

• Update with invalid position


Transient errors

• Invalid data used with SCRNRST, STATEREST,WINREST or TRAPREST

• Return or trap on an unloaded module


Utilities

• I need to delete a bunch of bad claims from the system


Utilities

• Select the queue


Utilities

• Re-adjudicate claims program


• Re-price/research claims program

Utilities


Utilities


Utilities

• Used to get rid of ‘abandoned’ workflow jobs


Utilities

• Re-sort by queue or rule


Utilities

• Re-sort workflow


Utilities

• Promark EDI claims load


Utilities

• Input text file name


Utilities

• Accumulator load


Utilities

• Enter file name


Utilities

•REC_PUNBR DIM 3 1 - 3 '.Underwriter No

•REC_GRNBR DIM 3 4 - 6 '.Group No

•REC_SSN DIM 9 7 - 15 '.Social Security No

•REC_SEQ DIM 2 16 - 17 '.Dependent Sequence

•REC_PRODUCT DIM 2 18 - 19 '.Product Type

•REC_YEAR DIM 4 20 - 23 '.YEAR

•REC_DESC DIM 37 24 - 60 '.Description of the record

•REC_DAMT DIM 14 61 - 74 '.Amount in the record

•REC_DVISCNT DIM 6 75 - 80 '.Visits

•REC_ACTION DIM 1 81 - 81 '."A"dd OR "O"verwrite

•REC_FILLER DIM 1 82 - 82 '.Filler

•REC_ACCDATE DIM 8 83 - 90 '.Event Occurred Date


Utilities

•Descriptions to update each record:

•"PAID THIS YEAR"

•"STANDARD DEDUCTIBLE"

•“STANDARD DEDUCTIBLE CARRYOVER"

•“STANDARD OUT-OF-POCKET"

•"STANDARD O-O-P CARRYOVER"

•"IN-NETWORK DEDUCTIBLE"

•"IN-NETWORK DEDUCTIBLE CARRYOVER"

• “IN-NETWORK OUT-OF-POCKET"

•"IN-NETWORK O-O-P CARRYOVER"


Utilities

• O9SYSIDX

- This is a batch system re-index that can be scheduled by your network administrator

- Or, If you are ASP we do it for free!

• O9EXCWK2

- This program is also a batch program that helps to recover claims that have fallen into the ‘black hole’


Reporting a problem

• Help us help you – Give us specific information and examples


Release schedule – 2014

• 4.11.00 – TEST - April 9 / PROD – May 10

• 4.11.01 – TEST – July 23 / PROD – August 9

• 4.11.02 – TEST – Oct. 22 / PROD – Nov.22


Resources

CMS – See HIPAA section

www.cms.gov/home/regsguidance.asp

CMS – ICD10 and 5010 updates

http://www.cms.gov/ICD10/

HIPAA Implementation Guides

http://www.wpc-edi.com

Online Support

www.eldoinc.com

Eldorado Support Team

[email protected]

(602) 604-3100

ext: 709 EDI

ext: 710 Admin

ext: 711 Claims

After hours support:

(480) 303-1199

http://www.cms.gov/home/regsguidance.asp




http://www.wpc-edi.com/



http://www.eldoinc.com/

mailto:[email protected]


Questions and Answers

Documents

May 2014 Troubleshooting Presentation by: Kurt Kubishke, Eldorado Rod Wall, Teamsters Troubleshooting