Hello,

Has anyone had claims deny from Health Partners with the code 50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.)?

Since January 1 all our psychotherapy codes have been denying with this code...weird.

Thanks

What do most providers use as a diagnosis for billing when clients come in one time and the therapist does not get enough information to complete a diagnostic assessment?

SCHA just started processing claims this week and denying claims that end with a bill type of 1 if the the patient status is not discharged. Procentive has all of our outpatient claims processed as 0891. It sounds like we can change it in Procentive that the bill type always ends in 1, 2, 3, or 4. I am thinking of having them all process as ending in 3 so the majority of claims get paid. But am still contemplating the best way around this situation that is the least labor intensive so am looking for ideas on what others are doing.

SCHA states they are still looking into this and they were not aware of the change either but have been getting calls from other providers about this. They believe is may be a CMS edit that they are following. Has anyone else gotten any other feedback from SCHA or Procentive about this? Is any one seeing other payers implement this new change that I should be aware of? 

Is anyone having issues with the eligibility module not giving them a response back for clients that have MN MA or a PMAP?  We were having no issues getting responses back on Monday (2/12) but starting Tuesday (2/13) we run the check and we don't get an error nor a response.  Any other payer besides MN MA/PMAP's are working, without issues. 

Procentive said they haven't heard from any other provider, so they are of no help on this and they can't see anything on their side that would be causing this.  We didn't change a thing from Monday to Tuesday that would be causing this either, so we are at a complete loss here. 

All the claims I submitted yesterday, for all payers, were rejected for "Error Message: Element NM103 (Name Last or Organization Name) is missing. This Element's user option is 'Must Use'. Segment NM1 is defined in the guideline at position 2500."

Did this happen to anyone else?  Wondering if this is Procentive problem or if something changed somewhere in our setup.

Thanks!

Hello, 

I am getting a rejection from SCHA for a chemical health assessment (H001 0900) for just one client stating:

Category: Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Status: Claim/submission format is invalid

Category: Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Status: HCPCS

Category: Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Status: Date(s) of service

I have verified eligibility for the date of service.

I opened a ticket with Procentive and they are saying that I need to send the claim as a Professional claim but we have ALWAYS billed as institutional without errors. I am SO confused and frustrated. Has any other CD billers ran into this issue with SCHA? Was there an update I missed regarding SCHA not accepting assessments as institutional claims? 

Thanks, 

Katie 

When billing Professional claims (Institutional box unchecked in "Create New Invoices"), we frequently get the message "A supervisor with a valid NPI is required."  Is this a setting in Procentive that triggers the notification or just a default of Professional billing?  If it's a setting, where is it found?

Is anyone else noticing a huge influx of rejections within the Electronics module? We would rarely get rejections and now it seems like I can hardly keep up and I have no idea what the issues are. I understand the issue with Blue Plus does not help but I am also seeing other payers rejecting and I'm wondering if there is an issue within Availity? I have created tickets for help but that seems to be taking foreverrrrrr. Example of a rejection - billing UMR for a client we have received payments previously and it appears most of the client claims are being accepted but a couple random ones are rejecting stating  "Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Status: Subscriber and policy number/contract number not found." Just feels like i'm going in circles in the electronics module.... Can anyone relate? Or help?? 

My password has been rest 3 times and I could not get into Procentive with either.

I do nto know hwat category to put this in.

We are trying to confirm which commercial health plans allow clinical trainees (incident to billing).  We've confirmed that most BCBS commercial plans and all Pref One plans allow it.  Has anyone had success with Healthpartners-commercial?  I can't get a confirmation from that insurance network.  We are billing Hpart-PMAP without any issues.  Any current information for clinical trainees would be appreciated.  Thank you.