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Direct Access and Authorizations

Jason L 2 week geleden in Billing/Electronic Modules bijgewerkt 2 dag geleden 7

Thought this might be helpful... I've added the authorization # of 88888888888 to the authorization field for our MA payer and submitted claims for Direct Access services, and they show as set to pay. I know from talking with others there were ideas around adding a new payer in order to accommodate one payer that can include authorization numbers on claims (Rule 25 clients with SA #s) and a separate payer that can exclude authorization numbers on claims (Direct Access clients)..

DAANES authorization numbers default to 8888888888 and using that on claims seems like it will work, allowing one MA payer, where Rule 25 clients can have actual SA #s (as they always did) and Direct Access clients can have the default authorization number of 88888888888.


Duplicate Diagnoses

kajohnson 4 dag geleden in Billing/Electronic Modules bijgewerkt door Jason L 3 dag geleden 2

Question about the functionality of the Diagnosis tab as it relates to Inpatient (Residential calendar) billing.  The Diagnosis tab on the Change Client window has the capacity to record detailed, extensive patient diagnosis history, but when it comes to billing inpatient/residential claims through the residential calendar in the time module, all the distinctions from that tab are lost - it seems the full history is pulled in to the claim, regardless of program, date, or status.  Is there a way to use the full capacity of this tab and not have most/all (including duplicates) pull into the claim?



We received information from Availity stating there may have been an issue with some ERAs from Anthem recently,

Please go to our Live Updates page for more information.

Thank you!


Has anyone obtained a letter from Medicare that says Medicare will not reimburse a provider or providers because of licensure?

Kim Ross 3 jaar geleden in Billing/Electronic Modules bijgewerkt door Mark Cornell 5 dag geleden 7

We have a case where Americas PPO (Mayo Health Solutions) will not pay our claims unless we either send a Medicare EOB or a letter from Medicare to substantiate that the services is not reimbursed by Medicare. Because these types of claims don't get processed by Medicare b/c the provider is not in network, we don't get an EOB. How are we able to get a Medicare letter documenting provider ineligibility for Medicare reimbursement?  

Thanks so much!



Integrated Credit Card Processing

Kari Droubie 3 jaar geleden in User Group Help bijgewerkt door sarah 2 week geleden 6

My organization is considering Integrated Credit Card Processing.  For those of you currently using this feature, would you recommend it?  What are the pros and cons you would suggest considering before moving forward?