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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?

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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.

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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? 

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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.

Thanks



+1

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?