Wednesday, December 2, 2015


Originally Posted 11/20/2015    (reposted 12/2/2015)

TCMS VERSION was released earlier this week and is now available...

When adding a new insurance carrier in the Insurance Carrier Setup screen, the box labeled "Use ICD-10 Code" will now be "checked" by default.
An updated ICD-10 master list is now available and can be uploaded from the new "Update ICD10 Master" Setup screen. Once the Master List is updated, the Diagnosis Setup screen provides the option to access the Master List and allows for code updating from it.
The Document Queue's drop-down labeling order now displays in the order selected in the Document Queue Setup screen.
Reason code PR45 will no longer be identified as a non-allowed amount while importing and posting an ERN file.
The detailed Daily Transaction report will display ICD-9 and ICD-10 diagnosis codes based on the ICD-10 flag in Setup.
The process for closing a month was slowed in the previous version due to a scripting issue that is now resolved.
In the previous version, after converting to ICD-10 diagnosis coding, some of the (now defunct) ICD-9 codes that were selected as preferred diagnosis codes would still remain selected in the background of the software. This would cause some ICD-10 codes to become unavailable. This problem is now resolved.
The Export Detail feature, available in the Bulk Claims Write-off wizard screen, was not reflecting ICD-10 codes. The feature will now reflect all diagnosis codes as they are within the service (either ICD-9 or ICD-10).

The patient credit balance report was sporadically failing to print in the previous version. This problem is now resolved.
In the scenario where a referring doctor is not required, but one is selected on an appointment, the selected referring doctor will carry over through the whole process from the appointment to the electronic superbill and superbill queue, until the service is generated.
A newly required Worker's Compensation form number C4.0 (10-15) is now available.
The documents in the Queues Setup screen and the "Move to" queue screen will now list the documents in alphabetical order.

The batch report was not reflecting ICD-10 codes. The report will now reflect all diagnosis codes as they are within the service (either ICD-9 or ICD-10).

While writing a claim, the services that are automatically generated through the explosion code feature were limited to four diagnosis codes. Now, in this version, the explosion codes will generate up to 12 diagnosis codes when they are available.

The audit log for a specific service was not reflecting ICD-10 codes. The log will now reflect either ICD-9 or ICD-10 as applicable.

The Export Claim Information feature was not reflecting ICD-10 codes and was still limited to four diagnosis codes. The Claim Export will now reflect all diagnosis codes as they are within the service (either ICD-9 or ICD-10) and will also reflect all diagnosis codes, up to 12 when they are available.
A problem that was causing an occasional SSL error message while creating a claim file or while checking a patient's eligibility is now resolved in this version.

The procedure code (CPT code) column in the Aging report was cutting the first digit. This problem is now resolved in this version.

Worker's Comp forms were generating a 998 error while printing due to diagnosis code descriptions that were longer than the 120 character limit. This problem is now resolved in this version.

A potential mismatch within the unsent flags feature between a claim's flag and the claim file, which would have caused a problem recognizing what was sent or unsent, was discovered and corrected in this version.

Printing bulk secondary HCFA's was generating a syntax (998) error. This problem is now resolved in this version.
The Aging report was not reflecting ICD-10 codes. The report will now reflect all diagnosis codes as they are within the service (either ICD-9 or ICD-10).

Printing the ledger history on a specific service was not reflecting ICD-10 codes. The history will now reflect all diagnosis codes as they are within the service (either ICD-9 or ICD-10).

Creating an e-track was generating a 404 (file/directory not found) error. This problem is now resolved in this version.

Monday, October 5, 2015


Some clients are still using ICD-9 diagnosis codes while creating claims for October services… this is a big mistake! All service claims submitted to a carrier must contain ICD-10 diagnosis codes.

The primary cause for this mistake should be most noticeable to the user while creating/generating services for October services… that is, the user will only see ICD-9 codes to select from because that patient’s insurance carrier does not have the option to “Use ICD10 Code” selected in the Insurance Carrier setup screen. When this option is not selected, the user does not see the available ICD-10 diagnosis codes while writing/generating a service claim and the services will not upload to an electronic claim file with the desired ICD-10 diagnosis codes – causing undesired rejections by the carrier.

All insurance carriers in the Insurance Carrier setup screen should have the option to “Use ICD10 Code” selected… and the Insurance Carrier setup screen offers an option that allows for a bulk selection of the “Use ICD10 Code” option all carriers. If, for some reason, you find it necessary to use ICD-9 diagnosis codes for services performed in October with a specific insurance carrier, the mentioned option can be unselected for that carrier.

We will soon add a warning while creating an electronic claim file that will alert the user of existing post-October 1 service claims containing ICD-9 diagnosis coding.

Friday, September 25, 2015



TCMS VERSION is now available...

The UB-04 form is updated to include:
1.      Policy Number next to patient name

2.      Box 17 fields

3.      Ganging up of up to 8 pair of occurrence codes and dates

4.      Ganging up of up to 12 pair of value codes and amounts

5.      The referring physician (box 78)

6.      The operating and attending physicians (pulls from the master physician list)

7.      Automatic additions of master physicians (in Setup) if the supervising doctor used in existing UB-04 claims (originally drawn from referring doctor list) is not found in the master physician list

Added the option for "Child Health Plus" on the pull-down in the VFC (Vaccines for Children) section

After saving a scanned document, the user will now be prompted to move the newly added document to a queue. The user can select the desired queue or hit cancel.

An open schedule screen will now refresh immediately after an appointment is cancelled.

The unsent claims report now offers the ability to limit results by insurance type and/or carrier.

An appointment’s properties is now utilized to identify the profile to be used to confirm authorizations from the scheduler. This will correct the confusion caused when a patient has multiple active profiles or when personal injury profiles are involved.

The selection field named "Use ICD10 code" in the insurance carrier setup screen is now audited.

The “I actively supervised” option on the worker’s comp form screen will now utilize the billing physician of the master physician (as it already is used with medical claims).

The caption of the “Sync ICD-10” option in the diagnosis code setup screen now reads '1X MAP OF ALL ICD9 TO ICD10' – a preventive confirmation after selecting this option is now also included.

An option to select all (or deselect all) ICD-10 codes shown in the mapping list is now available.

The option to “Add from ICD-9 Master” is no longer available.

Electronic statements now provides an option to preview a list of patients whose statements be generated.

Electronic statements will no longer split by location when these two practice defaults are not selected:
·        "Print Location Name on Per-Se statements instead of Practice Name"

·        "Print Location Address on Per-Se statements instead of Practice Address"

The payment analysis report now offers an option to include services (within the service date span selected) that have no payments

A practice default labeled “Suppress ICD-9 printing on Superbills" now reads "Suppress diagnosis code printing on Superbills"

The “currency” field length on many reports are now extended from 10 characters to 14

The document queue’s displayed order in the drop down box will now reflect the order projected from the queue’s setup screen.
The locations available in the user setup screen are now alphabetized.

Wednesday, September 23, 2015



Do you need information on setting up and using ICD-10?
Here is some helpful documentation:

This documentation is intended to walk you through the steps of setting up, and the use of, ICD-10 diagnosis coding in your Criterions BROWSER (Note that you must be on Criterions Browser version or higher).
Click Here (Criterions Browser only)

This documentation is intended to walk you through the steps of setting up, and the use of, ICD-10 diagnosis coding in your TCMS.exe (Note that you must be on TCMS version or higher).
Click Here (TCMS.exe only)

This documentation is intended for those who have purchased the ICD-10 "mapping" feature.
Click Here (only if you've purchased "Mapping")


Tuesday, September 22, 2015



CMS will appoint an Ombudsman (an advocate) that will help triage and address your ICD-10 issues and concerns with representatives in CMS’s regional offices. You can email the ICD-10 Ombudsman at

Please read through this CMS document for more information:


Are you prepared or making preparations for ICD-10?
Most of our clients have!

Criterions or TCMS will only convert or select an ICD10 Codes set if you have downloaded the latest update and activated the date sensitive settings in your setup.
To enter claims using ICD-10 codes for services performed on or after October 1st, 2015, there are a few things you will need to do on October 1st, 2015.

  1. Make certain that you are using TCMS version or higher.
  2. Enter the ICD10 start date (10/1/2015) located at the bottom of the Practice Information section of setup
  3. Enable the “Use ICD-10 Codes” option in Practice Defaults (middle tab) from within Practice Setup
  4. Insurance carriers will need a checkmark in the option “Use ICD10 Code” in order to send ICD-10 formatted coding.
    • a)  To place the checkmark in all carriers at once, use the option (at the top of the Insurance Setup screen) labeled “Use ICD10 for all carriers”
    • b)  To place the checkmark in carriers individually: Edit the Insurance Carrier(s) to place a checkmark in the option “Use ICD10 Code” at the bottom of each carrier’s edit screen
  5.  Enter the ICD-10 codes you will need in the Diagnosis Code Setup screen.
    • a)  ICD-10 can be entered manually (FREE) or with Automated Diagnosis Code Assistance (FEE)
    • b)  Manual code entry assumes you have access to ICD-10 coding resources to assist with proper coding
For more details related to ICD-10 Readiness, click here 



Criterions EHR and TCMS solutions are currently ICD-10 ready and now offer automated functionality to assist practices as they transition to this new coding methodology. 
To learn more about the features and pricing of ICD-10 Automated Diagnosis Code Assistance, please consult the ICD-10 Readiness document.  In addition, practices opting for our automated ICD-10 solutions can complete the online ICD-10 Agreement



The threat of electronic claim  process redirection or interruption has been avoided.



March 9th, 2015  - 

Emblem Health is mailing letters to all clients stating “On April 1st EmblemHealth will end its Electronic Data Exchange (EDI) with Emdeon to submit electronic claims”

This notice, from Criterions, is to let you know that we are aware.  This is a contractual argument between the largest clearinghouse in the US and an equally large insurance payer. 

We expect to receive more details in the days to come as they feverishly work to resolve this issue.   We will keep all clients posted through notices, such as these, as we get this information.



There are two related items in this alert that will help prepare your office for its use in Criterion’s TCMS and Browser software.

One attachment is a written, detailed 14-page book… the other is an abbreviated movie that focuses on the software setup for ICD-10.

Below are the Documents for you to Download 



February 9th, 2015
A universal change to the URL used by all TCMS clients to create a claim file occurred this past Friday. As a result, our programming staff create a new version of TCMS (v. with only one enhancement that addresses the change.
Any clients that are using the TCMS browser, or EHR, are not affected by this change at all; however, if you are using TCMS, you will not be able to create an electronic claims file until you perform the update to this new version.
PQRS Deadlines are approaching 
February 28th, 2015 -  If filed using our EHR the 2014 filing deadline. Please note the enrollment with Quality Net (EHR Registry) can take significant time.
March 31st, 2015 - If filed using our recommended registry however registry may have cutoff by March 15th 2015
PQRS Measure filings are performed in 1 of 3 ways:
  1. Claim based filing for the entire year submitted along with routine claim entries  (Free)
  2. Filing through a certified registry service using a small sample population  (Service fee)
  3. Filing through our certified EHR (Free)
Since 2007 many providers filed PQRS measures allowing them to receive an annual incentive bonus for their participation.
In 2013 a penalty began when data was not filed.
In 2014 (Filing now) the number of required measures to avoid the penalty is 3 and if you file 9 you will get a .5% bonus
In 2015 you will be required to report 9 measures to avoid the payment penalty.
Criterions has two offerings for clients who did not do claims based reporting throughout the 2014 year.
1. Meaningful Use EHR Clients
For clients who are using the latest Criterions EHR in a meaningful way (collecting clinical data), Quality Net has said clients may export a file (QRDA file) from their EHR and import it into the Quality Net registry system*.
a.   There is no charge from Criterions for the production this QRDA files.
b.   This method for reporting is new, untried and agency verbiage is confusing or contradictory.  All of our communications with the registry indicate a provider only need to submit one measure to qualify for the incentive.  We do not make any warranty to this claim and are not responsible for any untoward outcome.  Their description is below:
1. Using a direct EHR product that is Certified EHR Technology (CEHRT) or EHR data submission vendor that is CEHRT, report on at least 9 measures covering 3 National Quality Strategy (NQS) domains.   If the EP’s CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the EP must report the measures for which there is Medicare patient data.  An EP must report on at least 1 measure for which there is Medicare patient data.
Please note:
We have found the registration process to be time consuming (18+ steps) so please begin immediately.
Also the Quality Net Site seems to work best in the Google Chrome browser.
EHR Version or our EHR is required to produce this file.  You version number can be found in the lower right portion of your browser’s Criterions login screen. 
2. Registry Based Reporting
Criterions will produce a file for clients who did not use the certified Criterions EHR in a meaningful way which will contain data on measures pertaining to most specialties.
a.   The cost, charged by the registry is $350 per doctor for file production and registry submission.
b.   Depending on the data available in your system, providers may be required to manually enter or select some data into the files to be submitted to the registry.