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HealthRules Payor—New Claims Platform Implementation for Medicaid

We continue our transition to our new claims processing platform called HealthRules Payor (HRP). We moved our entire KidzPartners (CHIP) product on October 1, 2019 and are now ready to migrate our Health Partners (Medicaid) product on May 8, 2020.

HOW THIS AFFECTS CLAIMS PROCESSING AND CLAIMS RECONSIDERATIONS
The transition will require a suspension of claims processing and real-time claims reconsiderations from Monday, April 27 through Tuesday, May 5. There will be no Medicaid or CHIP claim payments during this period. We will resume both functions on Wednesday, May 6. It is important to note that we have worked hard to bring our claim inventory down to minimal levels leading up to the transition to HRP. We will run a normal check cycle on April 24, prior to the transition to HRP. Our first check cycle after the transition to HRP will be on May 8, which will be smaller than usual. Our first full check cycle in HRP will run on May 15.

It is also possible for some claims to pay differently in HRP than they do in our current system. This is due to the use of broader industry-standard claim editing processes being integrated within HRP. If you disagree with payment on any claim we encourage you to follow normal procedures by calling our claim reconsideration team at 1-888-991-9023.

For our Medicare products, claims processing and real-time claims reconsiderations processing will remain unaffected for now. More information regarding the implementation date for our Medicare product will be shared soon.

MEMBER ELIGIBILITY
If you have any difficulty confirming member eligibility at the time of service, please contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m.

Resources
April 22: Full letter to providers about HealthRules Payor implementation update