Hello!,

We recently received rejected claims from BCBS PMAP for not having clinical documentation sent to the claims department. We have never encountered this problem before. I was told by a representative that I we needed to submit clinical for authorization AND to the Billing/Claiims department at BCBS? Has anyone else run into this issue? I was told by the representative that I can submit this information through Availity, although she couldn't tell me how? If anyone has any suggestions or comments, I would great appreciate it! We are billing for CD treatment residential treatment services. Thank you!

Does anyone bill for an External DA review & Explanation of Findings.  If so what codes are you using and does insurance pay for this?  Thanks

Is there a way for Procentive to send a notification to STAFF when a new appointment is added to their schedule??

From the Center for Connected Health Policy, CMS just released new guidelines for telehealth, including some changes for what I prefer to call telehavioral services. 

The guidelines include,

"Beginning July 1, 2019, the SUPPORT Act will add the enrollee’s home as an eligible originating site and remove the originating site geographic limitation on existing eligible telehealth originating sites (including the home) when treating for a substance use disorder or co-occurring mental health disorder through telehealth." 

So, at least for SUD/co-occurring treatment, things are continuing to evolve. 

We use CMS/Slyce to store / run payments via procentive.  I am wondering, since there is not currently a recurring payment option to set up payment plans or automatic payments on specified dates, if there are any vendors that Procentive works with that would integrate with the system?  For example, if I hire a vendor to do this for us, I don't want to have to enter the data twice - I'd prefer to upload payment info into Procentive somehow so I didn't have to rekey everything twice. 

Please let me know if there is a capability for this, and if so, which vendors can do this.  

It would be so helpful to have a link in the Client Dashboard to be able to add to an existing or create new "Client Note"

I really enjoy the "Save All" feature when entering payments in an ERA where all claims in that ERA require no special attention.  I think it would be great to be able to select multiple claims and be able to save all payments for the selected claims, leaving the claims that need attention unpaid.  It would just help reduce the time saving not having to save each payment individually in an ERA when there's only one or two claims that need to be addressed further.

I received notification that codes H0031 & H0032 will only be able to be billed as 1 unit and must have the modifier "UD" removed as of 01/01/2019.  MHCP posted a bulletin about these changes:

"The Centers for Medicare & Medicaid Services (CMS) has established a Medically Unlikely Edits (MUEs) of one unit for HCPC codes H0031 (mental health assessment by non-physician) and H0032 (mental health service plan development by non-physician) beginning Jan. 1, 2019. MUEs prevent payment for an inappropriate quantity of the same service on a single day. Currently, more than one unit is allowed for each of these codes when the UD modifier is included. The UD modifier will no longer be required and only one unit of each of these services will be allowed per day for Managed Care Organizations (MCOs) and fee-for-service claims beginning Jan. 1, 2019. Minnesota Health Care Programs (MHCP) will deny a claim line that includes more than one unit. MHCP will determine a per-session rate for H0031 and H0032 and will reprocess paid claims with dates of service beginning Jan. 1, 2019, once a new rate is established. (pub. 12/28/18, rev. 1/8/19)"

Since our claims are currently being denied, I contacted MN-ITS provider help desk to inquire about this.  Essentially they have no answer as to when the rate for 1 unit will be decided, or what that rate will be.

Has anyone come up with a decent conclusion how to bill for these properly?  Provider help desk did say they will automatically resubmit all claims that contain 1 unit.

Thanks in advance

Just wanted to say thank you on the great job done with adding the ability to add descriptions and archive documents in the payers tab!  The new features there have been more useful than I anticipated.

Thanks again!

One of our facilities has been relicensed with 24hr Customized Living, and part of the requirement is for all clients to have a summoning device on them, in the event they need staff assistance due to a fall, health issues, etc.  Does anyone have any recommendations on a call/summoning system that is reliable?

I'm finding some options that are either extremely expensive or cheap and appear to not be very durable/reliable.  If anyone has any input, we would greatly appreciate it.

Thanks!