New Claims System

New Claims System

New Core Administrative System Updates
Read information on the implementation of Independent Health’s new core administrative system:

Looking for our product portfolio crosswalk document? Access it here.

Overview of Independent Health's Member ID Cards

As we near the end of our transition to our new claims system, our only members remaining on our current claims system are our MediSource and Child Health Plus members. On September 1, 2015, these remaining members will move onto our new system and all Child Health Plus members will receive new member ID cards featuring new member ID numbers. MediSource ID numbers will not change during this transition.

We have been encouraging members to carry their new ID cards with them and to show them at provider offices and pharmacies. As always, WNYHealtheNet may be used to verify member eligibility and detailed benefit information. Also, please be advised that for commercial members that have transitioned to our new claims system as noted above, their member identification number has changed.

If a member does not have their new member identification number at the time of their visit, we recommend that you perform an eligibility search by using the member’s name and date of birth to get the most up-to-date plan information.

If you attempt to perform an eligibility search using their old member identification number that begins with an "A" and date of birth, you will receive the error message "Date of Service Not within Allowable Inquiry Period – Correct and resubmit." Please correct and resubmit by performing a name and date of birth search.

Updated Explanation of Payment Voucher for New Claims System

Independent Health is nearing the end of our transition to a new core administrative system called HealthRules. At this time, our current and new systems are running in coexistence and claims will be processed on both systems.

Some important details about coexistence of the two systems include:

  • Processing and payment schedules have not changed.

  • If you are a provider who has selected electronic funds transfer, there have been no changes, and you will continue to be enrolled in it on the new system. If you are currently receiving paper checks and would like to enroll in electronic funds transfer, visit http://www.emdeon.com/epayment/.

  • As we proceed with implementing the new system, the check and vouchers will be distributed as follows:
    • During the implementation process when both systems coexist, providers will be receiving one additional check and voucher combined for all lines of business processed through the new system.
    • Once the new system is fully implemented in late 2015, providers will only receive one voucher and one check.
    • Checks for our self-funded line of business will continue to be sent separately even after we are on the new system.

The vouchers you receive will include many of the same headings you are used to seeing on the current voucher but there will be a few differences. To help you sort through the changes and make it easier for you to locate where some of the headings have moved to, view the side-by-side comparison of the old and new vouchers.

New Professional Editing Tool

During this period of coexistence with our current system and new system, claims are processing on both systems. Professional Claims processing on HealthRules (our new system) will use our new professional editing tool, CES Version 5.2.1, which adjudicates claims consistently with industry standards sourced from NCCI, AMA, CPT and ICD-9 Guidelines. Click here to view our original communication.

General information and Q&A regarding new core administrative system

Part of the new system includes a new claims administrative system called HealthRules. Our current claims system, Power, and HealthRules will be running in coexistence until all of our members are transitioned to HealthRules.

A careful, methodical implementation process is necessary to ensure a smooth transition to minimize the impact to our external customers and to maintain our award-winning customer service and satisfaction.

Questions and Answers

Q: How will this change to HealthRules affect my practice?
A: Changes that will affect your practice are as follows:

  • Member ID Numbers
    New member ID cards will be issued as Independent Health transitions to the new system. The new cards will feature:
    • Different member ID numbers that are numeric or alphanumeric and have 11 numbers.
    • The same first nine digits for everyone in a family.
    • Random suffix for all dependents.
  • Payment Checks and Vouchers
    Currently, all providers receive one check and one voucher for each of Independent Health’s lines of business. As we proceed with implementing the new system, the check and vouchers will be distributed as follows:
    • During the implementation process when both systems coexist, providers will be receiving one additional check and voucher combined for all lines of business processed through the new system.
    • Once the new system is fully implemented, providers will only receive one voucher and one check.
  • Explanation of Payment Codes
    Payment code language may be different in the new system as new codes will follow the industry standard terminology.
  • Provider Numbers
    Although the new system will accept your Independent Health provider number, we are encouraging all providers to use their National Provider Identifier (NPI) numbers.

Q: What do I need to do differently?
A: The only thing you and your office staff need to do is continue asking members for their ID card so that you can update their card information in your system.

Q: Why can’t you provide me with a list of my patients’ new ID numbers?
A: We are not able to provide you with the new ID numbers due to concerns about our members’ protected health information, but the new numbers will be available in HEALTHeNET.

Q: Will my claim be denied if I submit a claim with a member’s old number?
A: No, the claim will not be denied. To help providers update their systems, we will be returning the member’s new ID number along with the provider patient ID number on both the paper and electronic vouchers.