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Rate Changes

KatieW 2 years ago in Payers Module updated by Shauna Dall 2 years ago 4

It would be helpful if Procentive had a feature to make rate changes apply automatically to all fee schedules on a specified date/time. 

e.g. We are increasing several of our rates by a % on 1/1/18 so it would be nice to schedule the change and have it go into effect for DOS on/after 1/1. As it works right now, we will have to be extra careful checking each DOS to make sure it was billed out with the appropriate rate for 2017 or 2018.

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Assessments for Medicare clients

sadie.twite 7 months ago in Payers Module updated by Tracy Filipi 7 months ago 2

Does anyone know if you can do an assessment for a Medicare client and bill for it even if you are not a Medicare contracted provider? We are looking to just do the assessment and then refer to a Medicare contracted facility.

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Which payers require a CLIA code on claims?

crystalp 8 months ago in Payers Module 0

We are going to start billing for Urine Drug Tests for our COD program and we received a CLIA waiver. I see in the payers module > rates > codes tab that there is a filter that says "Use CLIA code on claim"...does anyone bill UDTs and send their CLIA code with claims? Do you know which payers require it? Would is be best to contact provider services for each payer or our network reps? Specifically, the code we will bill is 80305 QW. Thanks for any help as this is brand new to our clinic.   

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Submitting services to Office of Justice Programs Crime Reparations Board

Rochelle Garcia 8 months ago in Payers Module updated by Laura Hulsey 8 months ago 1

I was wondering if anyone has submitted claims to this program that pays for mental health services.  They're requesting billing be submitted on HCFA 1500.  They are not Procentive payer and so Im trying to figure out a way to not have to fill out these claims by hand. Thanks

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Blue Cross Blue Shield of North Dakota

vpetrik 11 months ago in Payers Module 0

Does anyone know the Payer ID number for Blue Cross Blue Shield of North Dakota as of 1-1-2019?

Thank you,

Victoria Petrik

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MN PAYER CHANGES for BCBS PMAP --SCHA -- UCARE

The Minnesota payers BCBS/Blue Plus, SCHA/MMSI, and UCare are making updates within the next 2 months.  We will provide you with more details mid-November, but here’s what you should do now: 

Blue Plus PMAP (of MN)

The Change: 

  • BCBS is creating a new Payer ID number for Blue Plus PMAP to distinguish it from Blue Plus Commercial plans.
  • As of December 1st, 2018, all PMAP claims will need to be submitted to a new Payer ID number.
  • Procentive will automatically update the Payer ID in the new payer Blue Plus PMAP on December 1, 2018.

Action Required: 

  • Add the new payer "Blue Plus PMAP" (ID: SB720) to the Payers Module. Copy over current codes and rates from the BCBS PMAP payer.
  • Add the new payer to each client that has BCBS PMAP and begin using this new payer right away.  (Run Report 3070 in the Reports Module to see a list of all clients with BCBS PMAP.)
  • Inactivate the old BCBS payer for each client as you add the new one. 


SCHA/MMSI

The Change: 

  • SCHA/MMSI’s Payer ID will change as of December 1, 2018.

Action Required:

  • Fill out the Electronic Funds Transfer (EFT) form you receive from SCHA/MMSI.  
  • DO NOT fill out the Electronic Remittance Advice (ERA) form that they send you.  
  • At this time no change within Procentive is needed. 


UCare

The Change: 

  • UCare is creating a new Payer ID for UCare Family and Individual (currently called either UCare Choices or Fairview UCare Choices), effective as of January 1, 2019.
  • Procentive will automatically update the Payer ID in the new payer UCare Family and Individual on January 1, 2019.

Action Required: 

  • Add the new payer "UCare Family and Individual" (ID: 52629) to the Payers Module. Copy over current codes and rates. 
  • Add the new payer to each client that currently has either UCare Choices or Fairview UCare Choices. (Run Report 3070 in the Reports Module to see a list of all clients with these payers.)
  • You will need both the old and new payers for a client because the payer you submit to will depend on the Date of Service.  


Have further questions on what to do to prepare for these changes? Please submit a ticket to the Procentive Care Team.

Answer

Minnesota Blue Plus PMAP 2019 Payer ID 00562 Update

We are aware of the issue with the incorrect Payer ID being sent on claims for some agencies. Upon further research into this for you this morning, we have determined the cause to be one of the following:

Option one– The original communication was missed regarding this change and the Blue Plus PMAP payer you have in your payers module is still set to the old Payer ID of SB720/00720.
SOLUTION– 1. Add the new payer with the payer ID 00562 for all Minnesota Blue Plus PMAP plans and copy over current codes and rates
from the BCBS PMAP payer.
2. Add the new payer to each client that had BCBS PMAP and begin using this new payer right away.

Option two– If the above is complete and you are still receiving denials then it is due to Procentive allowing them to be sent to the old payer ID. We have already fixed this to prevent this from happening as of 10:00 am cst today.
SOLUTION– Resend any 2019 claims which were previously sent prior to 10:00 am cst on 1/14/19.

If you have questions, please create a ticket so the Care Team may assist.

Thank you,

Amanda Kaufmann

Customer Care & Training Specialist 

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    Tricare Authorizations

    Marsyl Warren 2 years ago in Payers Module updated by crystalp 2 years ago 2

    Has anyone successfully navigated the new Tricare online-only authorization request system? 

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    Does anyone use a provider enrollment service?

    Jonathan Beulke 2 years ago in Payers Module updated by StephB 2 years ago 2

    Our practice needs to enroll with 4 different insurance companies and are looking for ways to make the enrollment process easier in general.  Does anyone know of, or use, a service that will enroll our practice to these payers for us?  With how time consuming the credentialing process is, we're hoping to eliminate the headache.


    Thanks!

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    Payer Module

    Kali 2 years ago in Payers Module updated 2 years ago 4

    When I go into any Payer Module --> "Rates Tab" the remainder of the tabs that open up below the "Rates Tab" do not display the names.  They're cut off and I cannot read which sub-tab I am in under the "Rates Tab".    Anyone else experiencing this??

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    No Show Fees

    Rochelle Garcia 2 years ago in Payers Module updated 2 years ago 3

    Hello


    For the agencies that charge no show fees...do you have a separate payer for each client so that an invoice will generate for that charge.  Currently each code is attached to a payer so that when its sent to the billing module you can bill that payer but I dont want to bill the actual payer that is set up (like BCBS or MA) so how would I set the client's payer up to bill the client directly?


    Do you use a different invoicing system for these other types of (non-insurance) type client fees?