Plugin Name As Seen in VisEDI Installer License. Version # in CPS VIS FQHC/SFS Approval

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1 Product: VisEDI If you are currently using any of the plugins listed below, you need to download and update your database with the latest plugins. Plugin Name As Seen in Centricity Plugin Name As Seen in VisEDI Installer License Version # in CPS VIS FQHC/SFS Approval CYSFQHCApproval VIS FQHC/SFS Approval MC VisAvaility 837 Professional Claims Creator Availity VisAvaility RTE Creator VisAvaility File Processing VisClaims File Processing CR ClaimRemedi MBCMC 837 Institutional Claims Creator MBCMC VisClaims Professional PI MBCPI VisClaims Institutional PI VisClaims File Processing PI VisInstitutional Claims Creator VisMedicare FQHC File Processing UGSUB Insurance carriers are frequently making changes to requirements for FQHC claims, requiring Visualutions to update their EDI claim and eligibility file creators. Clearinghouses and /or Direct Filing carrier also periodically make changes to transmission protocols or response files. We also periodically add enhancements to the new releases / updates. To stay current with all carrier requirements such as Medicare FQHC PPS claim filing, Medicare A RHC claim filing, eligibility response changes from carriers, and remittance processing please be sure to download and install all EDI plugins for which you have a license. *** This update includes important updates for filing Medi-Cal FQHC claims with dates of service on or after October 1, *** This update also includes 835 Remittance changes to match changes made by GE as to the functionality of the none and ignore in the remittance processing settings. Once the VisEDI installer is downloaded and installed on the server, run update.bat to update all workstations, Citrix and Terminal servers to assure that users are accessing the most current plugins.

2 CYSFQHCApproval Version: Approval Logic added for utilizing both FQHC/RHC with Provider Based Billing (PBB). If visit was FQHC/RHC and only had a procedure that needed to split to alternate payer it was failing to split properly. Availity837 Version: Institutional /UB04 Professional / CMS1500 Additional functionality to report more than 99 lines for non-fqhc hospital claims Removal of Max procedure setting. New carrier setting - (carrier specific requirement for secondary claims). Primary claims will continue to use the settings selected on All Payers (2) & Clearinghouse tab for reporting of the Encounter Code. If this setting is not selected, the secondary will continue to report as they have previously based on settings selected. New setting will report the following: 1) Total fees of the primary claim on the Encounter Code (for 2 nd carrier) 2) The payment from the primary on the Encounter Code (for 2 nd carrier) 3) Sum up the Line Info (CAS values) from primary and report on the Encounter Code (for 2 nd carrier) 4) Report all CPT s sent to the primary with a $0.00 fee Updates / changes to process 835 remittance files to match changed logic by GE. ClaimRemedi Version:

3 Updates / changes to process 835 remittance files to match changed logic by GE. MBCMC837 Version: Institutional/UB04 Added changes for Wrap and secondary/crossover claim requirements effective dates of service on or after 10/1/17. Additional setup is required for new filing requirements. See setup documents on the Help Desk portal. Changes made to report a quantity of 0 on supporting procedures. MBCPI837 Version: Institutional / UB04 Professional /CMS1500 Additional functionality to report more than 99 lines for non-fqhc hospital claims Removal of Max procedure setting. New carrier setting - (carrier specific requirement for secondary claims). Primary claims will continue to use the settings selected on All Payers (2) & Clearinghouse tab for reporting of the Encounter Code. If this setting is not selected, the secondary will continue to report as they have previously based on settings selected. New setting will report the following: 1) Total fees of the primary claim on the Encounter Code (for 2 nd carrier) 2) The payment from the primary on the Encounter Code (for 2 nd carrier) 3) Sum up the Line Info (CAS values) from primary and report on the Encounter Code (for 2 nd carrier) 4) Report all CPT s sent to the primary with a $0.00 fee Additional/Updated functionality when an Insurance carrier has several different requirements for the same types of service.

4 Example: Individual behavioral services are payable under an Encounter rate and the Group behavioral services are paid at Fee for Service. The settings highlighted below can be selected and claims will still generate for non FQHC appropriately. The setting on the "Clearinghouses" tab can be utilized if the carrier "always" requires and Encounter Code or if no rollup or special parameters are set on the "All Payers (2)" tab. New remittance processing option will not adjust visit to Actual Allowed reported in 835 remittances. (carrier specific setting when the FQHC 2 nd carrier will pay up to the Encounter Rate when primary has paid up to the Actual Allowed amount)

5 Updates / changes to process 835 remittance files using changed logic by GE. UGSUB92837 Version: Institutional / UB04 Remittance processing Updates to Same Date of Service claims, when the primary carrier paid $0.00 on both same d/o/s claims, the AMT*D (paid amount) was not reporting the $0.00 properly. Updates / changes to process 835 remittance files using changed logic by GE. 1) Remittance settings <all> row set to none for action balance on line item will transfer to the patient if no