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Hennepin Health (HH) ERA Adjustments?

Jeremy Roelofs-Lynch 1 month ago in Payments/ERA Modules updated 6 days ago 11

Hello, we have noticed that over the last few weeks our HH ERAs are coming with a bunch of adjustments; even though they paid the full amount. It is causing me to go in and manually change all the lines before saving it. 

I am curious if anyone else has seen this?


UCare denials - authorization

Good morning!  Curious to know if other facilities have recently seen UCare denying claims with the CO-197 denial code (authorization) for claims you sent that had the authorization number attached and the auth was valid?  The two facilities I bill for, I've seen this happen with several clients on the past couple of remits, so trying to gauge if this might be a more global issue with them right now.


unpaid CCD balance for returning client

Kim Ross 1 week ago in Billing/Electronic Modules updated by sarah 1 week ago 1

At times, we have clients who return to services with a previously unpaid CCD.  (We don't send past due accounts to collections.)  

In this particular case, the CCD is a result of a termed MA PMAP, after which the clinician continued to provide services. Balance owing is close to $1000. (We were hoping for a retro so didn't suspend services...)

Now the client returns having once again obtained an active MA PMAP plan.

What would you do in this situation? 


Aetna processing as if secondary to Medicare

Tina B 2 weeks ago in Payments/ERA Modules updated 2 weeks ago 2

Wondering if anyone has ever come up against this.  Client has Part A Medicare, no Part B.  Client was in IOP and Aetna has processed claims as if Medicare is primary and adjusting off most of the charge. Aetna is telling us this is a penalty since the client declined Part B Medicare. I don't see how they can do this. They are penalizing us, not the member.



Has anyone else attended the DHS trainings regarding direct access billing and/or DAANES entry changes?

LaVonne James 2 weeks ago in Billing/Electronic Modules updated by Jason L 2 weeks ago 2

It looks like there are going to be many changes in order to bill MNITS for 1002, H2036 and H2035. Is Procentive aware of these changes and updated the software accordingly?