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UCare denials - authorization

Heather L. Heim 3 years ago in Payments/ERA Modules updated 3 years ago 2

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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Aetna processing as if secondary to Medicare

Tina B 3 years ago in Payments/ERA Modules updated 3 years 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



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Hennepin Health (HH) ERA Adjustments?

Jeremy Roelofs-Lynch 4 years ago in Payments/ERA Modules updated 3 years 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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BCBS Blue Plus Assessements

Jeremy Roelofs-Lynch 4 years ago in Payments/ERA Modules updated by Kim Ross 4 years ago 6

BCBS posted a Provider Bulliten on 4/10/2019 stating that as of 5/1/2019 we should bill the R25 Assessment with the HF Modifier to distinguuish between it and the Comprehensive Assessment. 

Yesterday we received two ERAs for DOS January - April 2019 where they reprocessed ALL of our R25's as Comps since they were billed with no HF Modifier. The communication I have clearly states it went into effect on 5/1/2019. We get paid more for our R25 so it is resulting in a large takeback.

Thoughts?

Jeremy

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ERA import delay

Valerie McNamara 4 years ago in Payments/ERA Modules updated by Chris Werner 4 years ago 7

Has anyone else noticed a delay in how long it takes to see ERAs from MN-ITS in Procentive?  There has has always been some lag, however we don't have our yet.  It looks like the files are available in MN-ITS as of 9/13 but not into Procentive yet....

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ERAs for 6-23-20

Tina B 4 years ago in Payments/ERA Modules updated by John-Debbie Trunk 4 years ago 6

Just wondering if others have received their ERAs for today.

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Takebacks

emilee miller 4 years ago in Payments/ERA Modules updated by Chris Werner 4 years ago 6

Insurance termed so I posted the takeback to the clients account. What exactly are the next steps that I need to do so I can rebill this to secondary ins for the full amount of the claim??? 

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Shortfalls of Payment Entry Mode; Solutions Requested

John 4 years ago in Payments/ERA Modules updated by Valerie McNamara 4 years ago 2

Buckle up, this is a deep dive.


To understand the nature of the question, it is important to first understand that when my organization sends claims, each day usually has more than one service line for the same code, because clients attend more than one "group" in one day and the services are billed separately. So as a result, we have multiple service lines, for the same client, on the same day, with the same code.

When posting payments, my organization requires payments to be applied in proportion to the number of units to which that payment is being applied.

With this in mind, I am trying to find a way to prevent Procentive the following universal problems:

—Automatically adjusting off money that I want to leave as a balance

—Applying co-pays more than once on treatment days where we bill 2 separate "chunks" of time rather than all units on a single service line

—Improperly allocating funds respective to unit counts (This is my biggest issue with procentive overall. see below)


When, for example, the allowed amount (B6) is 50% of what was submitted, The claim is sent as 3 units and 1 unit of the same code, but the remit bundles these into one lump sum for 4 units. So, Procentive will:

-Put all the money on the line with 3 units

-Adjust the remaining balance

-Adjust 100% of the remaining 1 unit. 


In this scenario, I need to manually tab through every field in payment entry mode to ensure that 3/4 of what was paid goes on the line with 3 units, and 1/4 goes to the line with 1 unit. The only time Procentive gets this right is when B6=100% of submitted charges. Adjustments, specifically, are causing the imbalance. 


(Using the "allocate payment" dialog is not a viable solution, it only works when [B6=100%] OR [there is only 1 CAS code AND all claims paid are in a contiguous time span AND only one client account is being paid on the remit.])


I don't know if this is something that can be fixed on the user end (I have tried messing around with the "rules" for the payment entry mode, and while useful for other tasks, I could not solve any of these problems using them, or any other settings within procentive.) This is a major time drain when payment posting, especially when there are copay/coinsurance/deductible involved. To speed things up I usually just apply the copay to one line where possible, but the payment per unit rule is not something I can do differently. 

Am I overlooking something that I could be utilizing? Can systems engineers write new code to address this? Do we need to change our billing process entirely if we want to avoid this problem? I have been trying to find a solution to this for over a year and I am completely stumped.

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mn care tax

Tina B 4 years ago in Payments/ERA Modules updated by John 4 years ago 4