Skip navigation

Sub-navProviders

Provider News
print

HealthRules Payor—New Claims Platform Implementation for Medicare

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 our Health Partners (Medicaid) product on May 1, 2020 and are now ready to migrate our Health Partners Medicare product on October 19, 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, October 12 through Tuesday, October 20. There will be no Medicare claim payments during this period. We will resume both functions on Wednesday, October 21. 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 October 9, prior to the transition to HRP. Our first check cycle after the transition to HRP will be on October 23.

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.

MEMBER ELIGIBILITY
During this transition period we will be unable to update member eligibility information for our Health Partners Medicare members on our provider portal and IVR system from October 11th – October 20th. 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
October 8: Full letter to providers