UPCOMING FEATURE LIMITATIONS IN TCMS

Effective March 31^st 2019, TCMS users will NOT be able to perform EDI functions.  You will need to use our Browser interface to perform any EDI functions (ex: claim submission, ERA or eligibility). 

 

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

 

These requirements come from HHS, https://www.hhs.gov/hipaa/for-professionals/breach-notification/guidance/index.html

As per NIST requirements for HIPAA http://dx.doi.org/10.6028/NIST.SP.800-52r1

 

Browser access, cloud or self-hosted, has always supported these.

 

Sample article on HIPAA requirements:

https://www.vmracks.com/resources/hipaa-compliant-hosting-insights/choosing-the-right-type-of-encryption-for-hipaa-data/

If you believe your office will be adversely affected please contact Criterions support or email support@criterions.com

 

TIME TO UPDATE TO TCMS VERSION 4.9.3

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.

 

 

EMBLEM HEALTH ELIGIBILITY INTERRUPTIONS

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.

ELECTRONIC CLAIMS FOR TRICARE AS OF JANUARY 1st, 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.

FAQ:

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 http://bit.ly/2jlj0H4.

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 https://www.wpsic.com/edi/edi-forms.shtml

(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)