Facets - Our New Core System

Affinity Health Plan will be implementing a new core system on July 1, 2008. This updated technology will allow for more efficient claims processing, membership enrollment and provider data maintenance.

All Medicaid, Family Health Plus and Child Health Plus membership, and claims for these Members with dates of service July 1 and later, will be handled in the new core system. All claims received for dates of service prior to July 1, 2008 (regardless of program), as well as membership and claims for services rendered to Affinity Medicare and Unicare Members, will continue to be processed in the old core system.

It is our hope that the transition to the new system will be of minimal impact to you, our provider community. Some differences will be evident, as both systems will operate concurrently for the remainder of 2008. Please note the following changes:

o System generated provider ID numbers: In order to process transactions for providers, core systems used by plans like Affinity generate unique system numbers. For many years, these “Provider IDS” have been used, for example, on plan communications, remittance advice statements, explanation of payments (EOP) and Member ID cards, and our providers have, in turn, used the assigned Affinity Provider ID number(s) for use in claims submission and plan inquiries.

You will now begin to see your old, as well as a new Affinity Provider ID, appear on documents you receive from us. This will mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters. Member ID cards generated from the new core system will also reflect the new system generated Affinity Provider ID number. Please note that your previously assigned Affinity ID number(s) can continue to be used for paper claims and NPI dual file claims submissions.

o Affinity payments and EOPs for same claim processing cycle: Currently, payments for all claims received within a given cycle are lumped into a single check. However, after July 1, there may be times when you receive two separate EOPs and checks in the same cycle. This is because the new and old systems will be used to process different types of claims, based on dates of service and product. For example, claims received by Affinity with pre-July 1 dates of service will be processed in the old system, and claims received with post-July 1 dates will be processed in the new core system. Also, post-July 1 non-Medicare claims will be processed in the new system.

If you have any questions, please call our Customer Service Department at 866.247.5678, Monday through Friday from 8:30 a.m. to 8:00 p.m., and Saturday from 9:00 a.m. to 3:00 p.m. You may also visit us at www.affinityplan.org. We will be updating our web site with any additional information about our new system migration. As always, we appreciate your support and the care given to your patients, our Members.

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