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Ucare Internal Audit

Kayla Kenworthy 5 years ago in Billing/Electronic Modules updated by Shauna Dall 5 years ago 2

Hi Everyone,

Just got message from our Ucare rep saying they did an internal audit and need to recoup. Sounds like there was an internal issue. Did anyone else get called/emailed about this?

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ARMHS Providers

Leah T. 5 years ago in Billing/Electronic Modules 0

How is ARMHS billing going for other providers? Are you seeing shorted payments, a lot of denials, etc. Looking for feedback on any ARMHS billing experiences, issues, ideas, etc. Thanks everyone!

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Outpatient Mental Health

Leah T. 5 years ago in Billing/Electronic Modules updated by Valerie1 5 years ago 1

Just wondering with other outpatient mental health clinics, when doing psychological testing for commercial clients, do you require a certain amount down for the services ahead of time or just wait for it to all be ran through insurance? Example: Psychosexual evaluations.

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CW-Targeted Case Management MN DHS

ahuseby 5 years ago in Billing/Electronic Modules updated by Chris 5 years ago 5

We have recently become a contracted provider for providing CW-Targeted Case Management services and we are trying to bill for these services in Procentive and send them electronically to MN MA, but we are running into the claims wanting to error out for a diagnosis code.  What have others used for this diagnosis requirement?

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Room & Board code

sadie twite 5 years ago in Billing/Electronic Modules updated by Heather L. Heim 4 years ago 2

Does anyone in the community currently use another room & board code beside 1002? We are looking to bill room & board without the residential treatment for our teen clients. Do you know if this would be 1003 or something else? If it's 1003, do you know if you can bill outpatient services at the same time?

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BCBS MSHO plans

Derek 5 years ago in Billing/Electronic Modules updated by Lily 5 years ago 5

Has anyone had success billing clients with BCBS MSHO plans with policy numbers starting with JTM. The policy numbers changed in 2019 and are now being rejected saying that they must be submitted under the appropriate Medicaid payer names. I can't find what changed in 2019 or get any answers from BCBS

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Has anyone's MN DHS ERA's not come in this week?

KELLY PERFETTI 5 years ago in Billing/Electronic Modules updated by Katie Scharberg 5 years ago 15

I haven't seen that our ERA from DHS come in.  Does anyone know if there is a delay?

Answer
Amanda Kaufmann 5 years ago

Delayed ERAs from DHS


We are aware that DHS ERAs have not yet come in to Procentive from DHS.

DHS does have until Friday 5/3/2019 in order to process the ERAs in to our system.

Procentive is actively working with DHS to determine their resolution, and obtain a timeline that we can expect to see these populate in our system. In the meantime, the ERAs are accessible via the MN-ITS portal.

Please continue to keep an eye on this via the Live Updates Page. We will post here when we have obtained additional information from DHS. 

Thank you,

Amanda Kaufmann

Customer Success Manager

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Does anyone have a solution to billing claims for LPC for individuals with Medicare as Primary?

Does anyone have a solution to billing claims for LPC for individuals with Medicare as Primary?  I have an individual who wants to see our LPC, but has Medicare as the Primary insurance.  BCBS is secondary and they are denying claims stating it needs to be sent with EOB information from Primary.   What is the best way to get this claims processed by BCBS?

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Successfully billed Room and Board enhanced rates

Jenna 5 years ago in Billing/Electronic Modules updated 5 years ago 11

We were finally able to successfully bill the enhanced rates on our room and board line. It has always been on the grid rate sheet but we never were able to get it through. We billed enhanced rate with with child (U6) and medical (U5). After a few phone calls with DHS and asking the right questions we were able to bill directly on the MN-its website and get paid. 

Now when setting up our current clients with the room and board plus modifiers in Procentive it cannot clear their system. They say that DHS has been made aware of the issue that when sending in batch form it will not clear a revenue code with modifiers. Only a CPT code with modifiers. 

They also said that most people (like us before) just end up getting paid the base rate. So to test it out first. If entered right on MNit's you can get paid for this. It is a substantial amount of money over the course of a year billing out these rates. 

We are wondering who else is having this issue and if enough of us raise and issue with Procentive /DHS  the proper changes can be made so we can bill out of Procentive without having to go into MN'its directly to edit and bill the Room and Board w/ mods for every client in the facility. 

Answer
Amanda Kaufmann 5 years ago

Hello all, 

Procentive has been in contact DHS regarding the modifiers for Residential Codes. DHS is currently rejecting the modifiers on the claims, as including a modifier on these codes is not in alignment with 5010 billing guidelines. In speaking with them, they have acknowledge this and have told us they are working on it from their end.

Thank you to those that have shared their experiences and insights on how to get these claims acknowledged by DHS.
If you have further questions on this topic, or need further research into these types of claims, please contact DHS.


If anyone has questions on adding additional codes, associating codes with payers or adjusting rates for payer, please submit a Help Desk ticket.

Thank you,

Amanda Kaufmann

Customer Success Manager

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BCBS of MN requirement of combining practitioners on one claim per day for CD services

Doug Thole 5 years ago in Billing/Electronic Modules updated by KatieW 5 years ago 2

Does anyone else have a process through Procentive set up for combining multiple practitioner's claims for CD services on one UB claim per day?  BCBS is requiring this.