Hello,

Has anyone had claims deny from Health Partners with the code 50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.)?

Since January 1 all our psychotherapy codes have been denying with this code...weird.

Thanks

What do most providers use as a diagnosis for billing when clients come in one time and the therapist does not get enough information to complete a diagnostic assessment?

Has anyone started having troubles in the past week or two that there claims are denying on MNits for 132 and 153? I've been calling nonstop to DHS but always get the message that there is too high of a call volume and get hung up on. We are billing SUD IOP and its happening to all of the codes, H2035, H2035 HQ, H0038 U8 and T1016 U8 HN. Anyone have any insight on this or gotten through to them? We have four locations and its happening to all four so I think there is something bigger going on that's effecting all the claims. 

I know Medicare will credential LPCs as of 01/01/24, but will they credential an LPCC?

Has anyone else noticed that claims submitted  May 2, 2024 on have not fully submitted to completion.  Mine are sitting as sent and  have not reached the Received status.   

SCHA just started processing claims this week and denying claims that end with a bill type of 1 if the the patient status is not discharged. Procentive has all of our outpatient claims processed as 0891. It sounds like we can change it in Procentive that the bill type always ends in 1, 2, 3, or 4. I am thinking of having them all process as ending in 3 so the majority of claims get paid. But am still contemplating the best way around this situation that is the least labor intensive so am looking for ideas on what others are doing.

SCHA states they are still looking into this and they were not aware of the change either but have been getting calls from other providers about this. They believe is may be a CMS edit that they are following. Has anyone else gotten any other feedback from SCHA or Procentive about this? Is any one seeing other payers implement this new change that I should be aware of? 

Is anyone having issues with the eligibility module not giving them a response back for clients that have MN MA or a PMAP?  We were having no issues getting responses back on Monday (2/12) but starting Tuesday (2/13) we run the check and we don't get an error nor a response.  Any other payer besides MN MA/PMAP's are working, without issues. 

Procentive said they haven't heard from any other provider, so they are of no help on this and they can't see anything on their side that would be causing this.  We didn't change a thing from Monday to Tuesday that would be causing this either, so we are at a complete loss here. 

All the claims I submitted yesterday, for all payers, were rejected for "Error Message: Element NM103 (Name Last or Organization Name) is missing. This Element's user option is 'Must Use'. Segment NM1 is defined in the guideline at position 2500."

Did this happen to anyone else?  Wondering if this is Procentive problem or if something changed somewhere in our setup.

Thanks!

Hello, 

I am getting a rejection from SCHA for a chemical health assessment (H001 0900) for just one client stating:

Category: Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Status: Claim/submission format is invalid

Category: Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Status: HCPCS

Category: Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Status: Date(s) of service

I have verified eligibility for the date of service.

I opened a ticket with Procentive and they are saying that I need to send the claim as a Professional claim but we have ALWAYS billed as institutional without errors. I am SO confused and frustrated. Has any other CD billers ran into this issue with SCHA? Was there an update I missed regarding SCHA not accepting assessments as institutional claims? 

Thanks, 

Katie 

When billing Professional claims (Institutional box unchecked in "Create New Invoices"), we frequently get the message "A supervisor with a valid NPI is required."  Is this a setting in Procentive that triggers the notification or just a default of Professional billing?  If it's a setting, where is it found?