Monday, January 14, 2019


In compliance with HIPAA regulations we are updating our Business Associate Agreement with all Criterions ‘Covered Entities (clients).  This is mandatory for us to service your account.
To simplify this requirement and eliminate any question for conformity, we have reproduced the latest sample template provided on the Health and Human Services’ website. 
To update your BAA with Criterions, please complete the form at:
There is no need to print this form as it will be electronically signed with a copy emailed to you upon completion.  Thank you

Monday, January 7, 2019


Criterions and Application Service Provider Invoicing Changes 
·       All New York State clients will be charged NYS sales tax for all support services.

·       EHR fees, if not already adjusted for reference libraries, are billable at $135.00/month/provider.

·       eRx will now be invoiced annually by Criterions (previously invoiced by Application Service Provider). It will continue to be billed at our net cost.  There will be no sales taxes collected as these fees are for service transmissions received by the RxHub which is out of state.
·       EDI, Clearinghouse fees, previously invoiced by Application Service Provider (if applicable), will be added to your monthly Criterions invoice.  There will be no sales taxes collected as these fees are for service transmissions received by the Clearinghouse which is out of state. 
·       We will be transitioning for all invoicing to be done by email or ACH withdrawals.  If you wish to have mailed invoices there will be an additional fee. Please contact our office if you wish to discuss this option.

Wednesday, December 26, 2018


As part of our aggressive path towards best practices, performance, redundancy and security we must enable additional security protocols and ciphers to further protect and insulate PHI and as recommended by HIPAA.
Once enabled, the following features will not work in TCMS:
  1. ALL EMC/EDI features like
    1. creating claims
    2. sending a file
    3. retrieving reports
  2. Retrieving ERN files
  3. Eligibility Submission and result processing will not work
  4. Creating e-Track
Criterions is required to use AES (Advanced Encryption Standard) and TLS 1.2.
The executable version of TCMS cannot support these encryption protocols and ciphers
As per NIST requirements for HIPAA
Browser access, cloud or self-hosted, has always supported these.
Sample article on HIPAA requirements:
If you believe your office will be adversely affected please contact Criterions support or email

Thursday, June 14, 2018


Please update to TCMS version 4.9.3 as soon as possible. There are many enhancements, additional security provisions and some bug fixes for minor issues.
If you need any assistance or have any questions on how to update, please call us.
What’s included; enhancements to Patient Receipts, the Payment Analysis report, Workers Comp forms, Favorites in the Documents Tab, Eligibility checking on secondary and tertiary insurance carriers, Closing report, Referral Source report, and New HP1 forms.
Minor tweaks to: internal NDC tables, Referral Source report, the Fax Queue, No Fault batch management, Workers Comp Case management, reported allowed amounts of self pay payments, ERN posting, Debits display in ledger history, adding write-off reasons, auto-write-offs on zero-payments, Payment Analysis report, and the patient balance display in the Patient Search screen.

Friday, January 26, 2018


Emblem Health’s Eligibility inquiries are currently experiencing service interruptions. As result, Real-Time transactions are in a “Stand-In” status which generate response messages stating “Transaction Terminated” or “Timed Out.” 
Change Healthcare is addressing this issue with the payer, however the payer’s IT team has indicated that a permanent fix may take several months – tentatively, June 2018.

Tuesday, January 2, 2018


Tricare has awarded the new Tricare East region contract to Humana Government Business Inc. to take effect for claims with dates of service 1/1/2018 forward.
Q: Will Providers be required to Enroll to bill for Tricare East?
A: Yes - Providers interested in serving TRICARE East members must submit an inquiry form to Humana GBA at
If you already have a current TRICARE contract on file with Humana Government Business/Humana Military, You do not then need to submit an additional inquiry. Your current provider’s network agreement on file with Humana GBA will be transitioned to the new TRICARE East Region.
Q: Will Providers wishing to bill Tricare East electronically for Claims and ERA services be required to enroll?

A: Yes.  Humana GBA has contracted with WPS to perform EDI delivery.  EDI Enrollment must be completed by all providers wishing to bill Tricare East through WPS EDI gateway.
Providers utilizing Change Healthcare should take the following action:
(1) Go to WPSIC website at
(2) Complete the EDI - Electronic Claims Submission (837) Provider EDI Enrollment for Claims Complete the ERA - Electronic Remittance Advice (835) Provider ERA Enrollment for ERA.
When completing the EDI registration you will need the following information:
Line of business: Tricare East
Submitter name: Change Healthcare
Change Healthcare Submitter ID: S000005 (ANNNNNN)

Thursday, December 7, 2017


If you have not begun working on MIPS for your practice, you still have time to avoid penalties for 2017 reporting.   You can avoid a penalty by following the guidance as shown through the AMA link below.  Submitting a measure through claims in this manner must be done by December 31st, 2017.

CMS is continuing to update and change measures and information regarding the MACRA / MIPS program.  Information is subject to change and is meant as general guidance only.  All questions related to specific situations of providers and practices should be addressed directly to CMS at or 1-866-288-8292.
The AMA has provided an instructional video on meeting minimum requirements for avoiding a penalty for the 2017 MIPS program.  Details of how this method impacts your practice or the ability to also submit for a 90 period and achieve an incentive should be discussed directly with CMS.

Wednesday, October 11, 2017


TCMS Version 4.9.2 is now available to all clients

Patient export now includes additional insurance information.
A “CO45” ERN Auto Writeoff named “Contractual” will not write off the CO45 amount from a secondary carrier.

A new user right allows the user to utilize the Export Transaction Information feature.
Move Account Number on ERN report and make field bigger so it does not line wrap

Two new options restricting the preview/import of Insurance Due services by either “Master Physician” or by “Service Date” are now available in the Collections Module.
A new Insurance Type Custom Field, if selected, will print the Mammogram Certificate number in Box# 32 of the CMS-1500 form.

The ERN Kick List now offers selections to display services that were posted and/or un-posted.
The ERN Kick List now offers a selection to display all reason and remark codes.

The ERN Kick List now offers a write off feature that will write off the user’s choice of either the balances of the charges shown on the list (the list can be reduced denominationally by column) or the amount connected to the reason codes shown on the list.
The Corrected Claims Tab of a service now offers an Emergency Indicator check box.

For Pediatric Practices only- Electronic Statements now offers an exception report after generating an electronic statements file. The report shows that have no guarantor attached, excluding that patient’s qualifying services from the file so that the user can correct.
No Fault and Workers’ Compensation forms will now utilize CPT conversion codes.

- Various other bug fixes

Monday, July 31, 2017


TCMS version is now available to all clients

A new Practice Default 'Do not allow changing default Master Physician in ESB' - If checked, will stop user from changing the tied to physician when saving an ESB entry.

When an ERN can’t post a payment but it does find the service, it will put a denial-related ledger entry along with a button to the corresponding EOB.
NF and WC profiles will now show injury date on the Make Appointment screen – this will assist users in selecting the appropriate case for an appointment and avoid billing the wrong insurance carrier.

The Patient Demographics screen now provides emergency contact and relationship fields, and you can now search by emergency contact number.
There is a new label available in the Print Labels menu called "Lab B" which includes: 1) account number, 2) patient last name, 3) patient first name, 4) patient age, and 5) current date.

A new column containing the “Last Service Written” date is now included when exporting the Patient List by Referring Physician.
A new option on the Procedure Code Setup screen, named “Bulk Copy Fees” will now provide the ability to copy full fee schedules from one year to another, and also includes an option to do so in all practices.

The height of a Document’s image while printing is now scaled down to 97% of its actual size to ensure that the bottom of the page does not cut off.
When selected, a new Practice Default named “Update all future appointments when patient insurance profile changes” will update scheduled future appointments when the insurance carrier or the case number are changed.

When both Practice Default selections named "Print Location Name on Per-Se statements instead of Practice Name" and "Print Location Address on Per-Se statements instead of Practice Address" are left unchecked, then Patient Statements will not split by location when a patient has services in more than one location.
The NDC number in Procedure Code Setup can now contain a default “quantity” amount that will default when the service is written.

The Claims Export feature now contains columns named “First Visit” and “Injury Dates”
The Claims Export feature now contains a column named “Applied From Credit Balance”

The Payment Analysis Report can now be generated to include multiple practices
The “Patient List by Patients Seen in a Service Date Span” now contains an option to “Show only patients not seen since” - by selecting this option, only the patients seen in the date span selected, but not seen after, will appear in the report.

A new option in the PQRS Export feature named “Insurance” will limit the export to Medicare services.

In the Documents feature, when there is only one document available in a category and it is made inactive, the document and the category will now disappear.
The Schedule Export now contains a new column called “Policy Number”

The ERN Auto Write-off feature can now process negative amounts received from the carrier (which will increase the service’s balance due amount).
The Referral Source report now has a new column named “Insurance” – when selected, the Insurance carrier name will be added in a new column in the export. By selecting the feature and adding the column, a service may be duplicated if it contains more than one carrier.

Taxonomy codes will now print on UB04 claim forms when available.
- Various other bug fixes

Monday, May 15, 2017


You may have already heard of the recent global cyber-attacks affecting over 200,000 organizations in over 150 countries known as ransomware. The “WannaCry” ransomware uses flaws in Microsoft software to spread quickly through networks and locking away files. There is no anti-virus that can fix ransomware.
Exercising caution can help to prevent an attack to your network.
So, what can you do?
Eliminate any computers running operating systems other than Windows, 7, 8 or 10.
Be sure to set Windows updates to automatic.  In this specific instance, we have found it better to also manually check for a Windows update.  Select “Settings, Windows Updates, Check for updates” and install.
Have anti-virus software installed on each PC.  We suggest and use ESET antivirus and for ransomware and trojans.  You can go to and download their free version.  Their lifetime subscription is better and we do have both available. 
Do not open unsolicited emails with attachments; especially from unknown or questionable sources, even if they address you by name.
Always type the website out yourself and resist clicking on any links that take you to seemingly authentic but fraudulent websites, or that warn you to change a password. Stay alert and be suspiciously cautious.
If you do become infected, you will need to disconnect the infected PC from your network and re-install Windows as soon as possible.