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Welcome Aspirus Medicare Advantage Providers

Page last updated April 23, 2024

Change Healthcare is experiencing a nationwide network interruption related to a cyber security issue that started Feb. 21, 2024. Aspirus Health Plan is monitoring this evolving situation and will update the information on this page as we learn more. Please check back regularly.

Recent changes:

  • April 23, 2024 – Within the “Remittances” section, updated the timelines for when providers will receive retro 835s based on the date they or their clearinghouse enrolled with Availity.
  • April 16, 2024 – Within the “Remittances” section, added clarity on when providers will receive 835s based on the date they or their clearinghouse enrolled with Availity.
  • April 16, 2024 – Within the “Remittances” section, added information about duplicate claim denials.

Impact to Aspirus Health Plan Medicare Advantage systems

The following electronic data interchange (EDI) transactions are impacted by the outage:

837s/277CA - Electronic Claims/Claims Response - Providers may check individual claims through the Aspirus Health Plan Medicare Advantage Provider Portal. Providers who are enrolled with Availity or whose clearinghouse is enrolled with Availity are receiving transactions.

  • 276/277 - Claims Status Inquiry and Response - Providers may check individual claim status through the Aspirus Health Plan Medicare Advantage Provider Portal.
  • 999 - Implementation Acknowledgement - Providers who are enrolled with Availity or whose clearinghouse is enrolled with Availity are receiving transactions.
  • 270/271 - Eligibility Benefit Inquiry and Response - Providers may check individual member eligibility through the Aspirus Health Plan Medicare Advantage Provider Portal.
  • 835 - Electronic Remittance Advice – Providers who are enrolled with Availity or whose clearinghouse is enrolled with Availity will have the option to receive 835s.

Aspirus Health Plan is in contact with Change Healthcare. At this time, Change Healthcare has not shared timelines when services will be restored for payers. We will update this page as we learn more.

Pharmacy

A small number of members are reporting the inability to receive their prescriptions when presenting to their pharmacy. Change Healthcare is commonly used as one of the national pharmacy switch providers by many network pharmacies for claims and payment processing. Some of our network pharmacies rely solely on Change Healthcare as a pharmacy switch and as a result may be unable to send Aspirus Health Plan/Navitus pharmacy claims at this time. This could result in some members being unable to receive their prescriptions. Impacted pharmacies are managing urgent or medically necessary prescription needs through emergency fill processes.

Prior authorizations

The outage is not affecting Aspirus Health Plan’s Medicare Advantage prior authorizations. Providers should follow our usual processes for submitting prior authorizations. See the Aspirus Health Plan Medicare Advantage Provider Manual for additional information.

Hospital admission notification

The outage is not affecting Aspirus Health Plan’s Medicare Advantage hospital admission notifications. Providers should follow our usual processes for notifying Aspirus Health Plan about hospital admissions. See the Aspirus Health Plan Provider Manual (Hospital Services chapter) for additional information.

Claim submissions

Providers may submit claims in the following ways:

  • Aspirus Health Plan is now able to accept claim submissions from Availity.
    - Providers can enroll directly with Availity or a provider’s clearinghouse can enroll with Availity.
    - For providers needing emergency assistance, connection to all payers via Availity Essentials will be offered at no cost for the time being. Click here to learn more. We will share information as we learn more.
  • Submit a paper claim. See the Aspirus Health Plan Medicare Advantage Provider Manual (Claims & Payment chapter) for details.
  • For claims that are affected by this outage, Aspirus Health Plan will extend timely filing by 30 days. Aspirus Health Plan will reprocess claims with receipt dates of Feb. 28, 2024, to April 12, 2024, that have denied for timely filing in situations where the number of days past the timely filing deadline does not exceed 30 days. Aspirus Health Plan will update this page when these claims have all been reprocessed. If you feel you have a claim that meets these criteria but did not get reprocessed, please contact us using a Reconsideration Form, and we will review.

Tips for submitting paper claims

  • Taxonomy Code Requirements: Professional and facility claims received by Aspirus Health Plan, must be submitted with taxonomy codes for billing and rendering or attending provider. When providers submit NPI(s) anywhere on a claim, the corresponding taxonomy must also be submitted. Provider types that are not required to submit NPI are not required to submit taxonomy on claims to Aspirus Health Plan.
  • If an unlisted procedure code is used, a narrative description is required on both the CMS 1500 and UB-04.
  • All services should be billed line by line and identified by Revenue, CPT or HCPCS codes, ICD-9-CM or ICD-10-CM codes, modifiers (when appropriate), location codes and units.
  • For paper claims, submit an original UB-04 or CMS-1500 form, and not a facsimile copy. Additionally, remove all staples, ensure print is dark enough to read and that you are using a standard-size font. Do not stamp over billing data—claims must be legible, and all data must be readable.
  • If the member has other insurance, submit a remittance advice from the primary insurance carrier with the claim.
  • Only one member or provider per claim.
  • Non-clean claims or unreadable claims will be returned to the provider.

Claim payments

On March 29, 2024, Aspirus Health Plan began mailing paper checks for payment dates Feb. 23 and forward to those providers who are set up to receive paper payment. Currently, Aspirus Health Plan is unable to bundle both the paper check and the evidence of payment (EOP) in a single envelope. EOPs are being sent separately.

Due to system limitations, providers receiving a paper check dated Feb. 23 to March 27 may receive a duplicate 835.

At this time, electronic payments are not affected by the outage. Providers are encouraged to sign up for electronic funds transfer (EFT)/electronic remittance advice (ERA). This can be done on the portal - select the “New Provider Payment and Remittance Selection Form” located under “Document Center Resources” in the “Resource Center.”

Remittances

Providers who were enrolled with Availity or whose clearinghouse was enrolled with Availity by March 14, 2024, received 835s for payment dates Feb. 23 and forward. Providers who enroll between March 14, 2024, and April 28, 2024, will receive retro 835s the first week of May. Providers who enroll April 29, 2024, or later will need to contact Aspirus Health Plan’s Provider Assistance Center at 715.631.7412 or toll-free at 1.855.931.4851 to request any retro 835s. For the time being, Aspirus Health Plan is not requiring providers to populate an Electronic Remittance Advice form on the Aspirus Health Plan Medicare Advantage Provider Portal once enrolled with Availity.

On March 18, 2024, Aspirus Health Plan began temporarily mailing paper EOPs for payment dates Feb. 23 and forward that are 50 pages or less to get remittances to the majority of providers. At this time, Aspirus Health Plan is unable to bundle both the paper check and the EOP in a single envelope. EOPs are being sent separately from the paper check and may arrive first.

All EOPs are being sent via paper regardless of whether a provider is enrolled to receive electronic remits. This may result in some providers receiving duplicate remit information.

Due to system issues at the clearinghouse level, Aspirus Health Plan received duplicate claim files on two separate occasions between March 23 and April 10. Providers may experience a higher incidence of duplicate claim denials on remits (835s and EOPs).

Helpful tips for providers

Aspirus Health Plan has collected the following tips to assist providers during the outage:

  • Individual member information - available on the Medicare Advantage Provider Portal or by contacting the Provider Assistance Center.
  • Viewing check payments, which may help you validate payment to members - On the portal from the dashboard, click “View Claims” and then search by check number. To see additional details per claim, click on the Claim Number hyperlink. Screenshots are available on page 24 of the provider portal user guide.