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KNOWN ISSUE: UBH/Medica Claims and ERAs

Ashley Morschen (Project Coordinator) 3 years ago in Known Issues updated 3 years ago 21

Claims submitted on or after 3/30/2017 have the "Sent" status in the Electronic module for payer ID 87726 and some ERAs are not yet flowing into Procentive. We are working with the clearinghouse to determine the cause of this however, they have verified that they are receiving the claims and they've been sent on to UBH/Medica for processing. We will update this post as soon as we have more information from the clearinghouse. Thank you!

Answer

Answer
Fixed

This has been resolved. After monitoring UHC ERAs this week they appear to be coming through daily. We appreciate your cooperation and assistance with this difficult issue. Thank you!

Our Engineering Team is working with the clearinghouse to resolve this issue as it has come to light that it's more technical than originally anticipated. We're sorry for the inconvenience this is causing and would like to make sure everyone is aware that your claims are being received and sent on to UBH/Medica for processing - this means there is nothing else you need to do with this claims. Thank you for your patience while we continue to work on this.

Fixed

This has been resolved. All claims from the 3/30/17 - 4/14/17 date range should now display their actual status in the Electronic Module instead of "Sent" . Please review your claims from this date range to make sure they were "Received". Any other status will require your attention. Thank you all for your patience while we worked through this.

Has the issue with the ERA's and Medica been resolved? They still are not downloading

Sherrie,

If you are still experiencing issues with UBH/Medica please submit a ticket to the Procentive Support Desk with specific examples.

Thank you!

We received numerous ERA's from Medica/UMR/UHC on 4/19, so they do seem to be coming through again.

Our Medica claims in the electronic module from 4/19 forward are showing "sent" only, again.

UHC/Medica ERAs still are not downloading. I just found 3 on Medica's website.

The Support Desk has received reports from customers of sporadic missing ERAs and some claims in the Electronic Module remaining in "Sent" status. It appears this issue is now intermittent so our lead systems engineer is working with the clearinghouse to find the source. We will continue to post updates as they become available.

Still, we've received payments from Medica and UHC but are not receiving the ERA's until at least 7 days past the payment date OR until I pull and post manually. In most cases I am pulling them manually from Optum Financial, as it is causing a delay to wait to receive the ERA's when we are trying to process and send out updated statements to clients.

I noticed beginning today 04/27/17 on our bank statement the description of the transactions have changed from HCCCLAIMPMT to DIR DEP Medica and/or DIR DEP UNITEDHEALHCARE. I'm not positive if this is a permanent change or not.

Answer
Fixed

This has been resolved. After monitoring UHC ERAs this week they appear to be coming through daily. We appreciate your cooperation and assistance with this difficult issue. Thank you!

Hi Ashley,

We are not getting UHC/Medica ERA's again and both payers read "sent" in electronic.  I have had to go onto optum's portal to access remittance advisories again.  When can we expect this issue to actually be resolved?

I, as well, have not received any UHC-related ERA's since 5/18.

We have not received any Medica/UHC EOB as of 05/18/2017 either!

I will start a new thread on this because there's a chance that since the thread is marked Fixed, she is not seeing our recent comments.

Our Medica/UHC invoices are still just reading sent and we are not getting new ERA's from them again.

We have not received any UHC/Medica payments since 5/18 either.


Also, we are noticing in our Electronic Module that claims are still in status 'sent' instead of 'received'.  Anyone else?

Thank you all for bringing to our attention that this has again become an issue. I've brought this to our Lead Systems Engineer who is in contact with the clearinghouse to identify and resolve this.  Another source of the issue has been identified and we are currently working to implement a resolution. Please check back here for updates, as well as in the ERA and Electronic Module.


I apologize for the length of time it is taking for us to fully resolve this and I know how important ERAs are to have in a timely manner. Unfortunately, this is an issue with the clearinghouse which means we are continually waiting for them to help us, help you. This causes issues to occasionally take longer for us to resolve than a Procentive issue and we want to thank you for working with us on this - and bringing it to our attention when something is missing.


If you have specific questions, please submit a ticket to the Support Desk so we are able to address them individually. 

Electronic module hasn't listed a UHC claim as Received since 5/18 as well.

We had 15 UHC ERA's come across today, 5/31 in ERA Module.


We did too. All under Payer UMR but at least we got them which was great!