I'm having an extremely difficult time getting a 245F withdrawal management claim to pay when billed out of Procentive to MA - both the treatment code with the room & board and only the room & board after it was billed to a PMAP.  I've spent an extensive amount of time on this in the last two weeks with Procentive and the MHCP provider trainer.  Here's what's happening:

Claims are being denied for units not matching date range (they do) and no DAANES entry (there is).  When I last spoke with the provider trainer, she advised me that our claims are coming into their system as a hospital claim and searching for DRG rates.  Procentive has confirmed that all of my settings are correct and that the claim going out the door all looks correct as well.  They did make one suggestion - I've been including all the dx codes given for a client on the claim and they suggested trying only the primary diagnosis.  I'll run a test claim that way as soon as I have one to run.

I'd love to know if anyone else has experienced this issue, and if not, how are you successfully getting your 245F claims to pay by MA?

The most recent MA remit is showing a denial remark code N21 “your line item has been separated into multiple lines to expedite handing”. I understand what’s going on, but DHS says its an issue on our end, and I believe its on issue on their end. This started to

Attention Procentive Customers:

We would like to inform you that we will be conducting maintenance on our systems Wednesday, October 16th at 10:00 PM CST/11:00 PM EST. Users will experience downtime for 30 minutes and potentially up to 2 hours.

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Attention Procentive Customers:

We would like to inform you that we will be conducting maintenance on our systems Wednesday, October 9th at 10:00 PM CST/11:00 PM EST. Users will experience downtime for 30 minutes and potentially up to 2 hours.

This maintenance is necessary to ensure that our systems are running at their optimal performance and to provide you with the best possible experience. We apologize for any inconvenience this may cause and thank you for your understanding.

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