Home Forums Discussions Problems Incomplete Insurance Database Version 6.6.5 build 121

Upgraded yesterday.

The problem we are having is the insurance migration because the insurance database is incomplete. Insurances need to be added to the database manually. I guess at some point when AC updates their database, these manual entries will need to be "matched" again.

In addition, if the insurance is not in the database the patient's individual insurance information needs to be reentered again.

We had a client upgrade a while back and the insurances in AC went berserk. This was understandable since before the upgrade they had entries for patients like:

BCBS
BC BS
BSBC

Each one became a separate carrier in AC. Instead of the client manually fixing all that, I took the insurance list and policy information from our system and populated it for them directly in the database. Took me 2 hours (we are their billing company). If you have a PM, you may want to investigate this as a fix but you'll need a data guy to do it for you.

JamesNT

Another bug

Generated orders come out BLANK when printed!

I generated the order the same way I always do. Select patient, generate order, select diagnosis,select order and enter details, then send to front desk for printing.

Front desk tries to print, but comes out blank.

I verified that the orders were entered correctly by viewing the order in the Cntrl-O window. There, I can see all of the details. When printed again, the orders come out blank.

To be more accurate the only thing printed is the patient demographics.

Is there a setting or switch on this new version that needs to be adjusted. Can anyone help?

Was this data entered through the migration tool of AC?

Something similar was a bug in previous version; when ordering a referral for someone who was not in the Rolodex it would only print the header information with demographics.
What kind of order was it?
Which version are you on.

Greg

The order was a referral to an orthopedic surgeon. We normally do not select a specialist by name, so it is probably something different. We just upgraded to the newest build with guardian angle support a couple of days ago. 6.6.5, build 121.

We are handwriting the details of the order until this can get sorted out.

Still no reply from support.

Our orders are doing the same thing. It is so frustrating!

James, it seems like that BCBS issue could have been easily fixed with the migration tool. It seems like once you define and active the Blue Cross plans you just migrate all BC BS to the new plan, then migrate all BSBC to the plan. Did I miss something? I'm going through the upgrade now.

Has anyone using Office Ally (or other clearinghouses) experienced any difficulties after insurance migration due to a difference in the way AC is designating insurance companies/plans and the way the clearinghouse does? Especially with Blue Cross. Empire Blue Cross is know to be difficult and heavy handed and I'd like things to go smoothly.

Wayne,

Unfortunately, that is not the case. Situations like my example will be regarded as very different occurrences to a computer. And as far as matching by plan, how is the software to know what belongs to the same plan unless you told it at one point?

The question is how much development time do you want AC to spend making fool-proof a tool everyone is going to use only once. I would venture, not very much.

JamesNT

James, oh ok. We have a lot of permutations of BCBS and other insurance plans also. Once I kinda figured out some things about the migration tool, I found it helpful especially for cleaning that stuff up. But the database seems to have some problems, and some of this may be whether things are explained fully.

I've just gone through codifying some insurance plans and migrating some patients. But I noticed that in some cases the address in the database is not the address listed on the insurance card. (United Healthcare for one). Or the Payor ID (for electronic submission of claims) is not the one on the card. While I may not expect them to get the entire database exactly correct (or, maybe I do) I do expect the Payor ID to be correct. And since they are requiring the address, I would expect them to correctly pre-load into the database the correct addresses for the largest insurers (All the Blues, Aetna, United Healthcare, Oxford, Cigna, 1199, and HIP). Maybe there are smaller plans that they have not yet added (like Conventry or PayorFusion). At least they are small here. And I am assuming the want the address to which claims are sent. If not, they need to say so.

There is also the issue of requiring and insurer name and the "plan name." Does that mean I really need to put in "Aetna" in one field and "Aetna Choice POS II" in the other? I hope not. If so, that should have been set up for Aetna initially, because 1) Aetna has about a zillion different plan names (and they keep adding them) and 2) Currently all I send to the Office Ally clearinghouse is "Aetna".

I think codifying the insurance companies is great. It is helping me clean up my list. But I do feel that for the major companies they should have prepared the needed information in the database. Of course, I'm assuming that this (largest, most used insurers) is only 10-15 insurers. I could be grossly underestimating that.

I guess on problem with Blue Cross is if one patient has say, BCBS of Alabama and it is only listed as BC/BS. Then another patient has BCBS of Florida and it is listed as....BC/BS. Doh! Yeah, we have that issues, only now all those people left in our system are only former patients so it doesn't matter what I do.

Other issues to consider:

What may be a small plan in your state may be gigantic in another state.

BCBS of North Carolina is no where near the same animal as BCBS of Texas, as an example.

JamesNT

James, you are absolutely correct. You have national players which may have more penetration in some markets than others. Then others that are pretty strictly regional or local. Sometimes a regional/local player can be rather dominating in its market area.

After living in several states through the years (DC, Maryland, NY, NJ and MN)and discussing this with a few people, I'd consider the ones you consider "large, national" to be BCBS (Any BCBS), Aetna, UnitedHealthcare, Cigna, Oxford (which is part of UHC) and maybe HIP (at least in NY, but maybe its regional/local) and 1199.

For these companies (and I may have missed some, or perhaps I missed many) I'd expect that database to be pretty much bullet proof. Now, no one has infinite resources, so you can't get everything in there perfect, at least not initially. But these I would expect to be. And as I mentioned, I'd include any BCBS in this list since its BCBS and they can be so dominant in their specific markets.

I was on with support this morning working with--Jody I think. If she's the Jody from a few years ago I know she's really good. At any rate, there were a few things that I misunderstood that she cleared up. In the end I'm sure things will work out ok,I'm mainly concerned that it doesn't affect our cash flow. You need to be particularly careful with changes that can cause you customers an interruption in their revenue.