We have a case where Americas PPO (Mayo Health Solutions) will not pay our claims unless we either send a Medicare EOB or a letter from Medicare to substantiate that the services is not reimbursed by Medicare. Because these types of claims don't get processed by Medicare b/c the provider is not in network, we don't get an EOB. How are we able to get a Medicare letter documenting provider ineligibility for Medicare reimbursement?  

Thanks so much!

Kim

Procentive has received the following notice from the clearinghouse:

Some 835's for UnitedHealthcare (payer ID 87726) from check date 03-09-18 through 03-15-18 are delayed. A ticket has been opened with the payer for further research.

We will update this post once we are notified the issue is resolved. Thank you!

I am reaching out to the community to see if anyone has experience with billing 96101 codes as a Clinical Trainee or predoctoral intern? I have my Master's degree in Applied Psychology, which qualifies me to do psychological testing. I also have nearly completed my 2,000 hours internship requirement toward my PhD in Clinical Psychology (all necessary coursework is completed). I still will be working on my dissertation however. At the conclusion of my internship, will I still be able to bill 96101 under the supervision of a licensed psychologist for private insurance? If an organization has any input, it would be greatly appreciated. 

Does anyone bill for Pharmacy services?  We have a PharmD (Doctor of Pharmacy) on staff and are trying to figure out how she can bill for MTMS (Medication Therapy Management Services).  We have been told by MN DHS (MA) that we can bill the codes related to this service.  The issue I am having now is that some of the clients also have Medicare.  We can only bill for Medicare Part B.  With her degree this would fall under Medicare Part D, which we are not able to enroll in because we do not have a pharmacy onsite. 

Any help would be much appreciated.

Thanks!

I recently read something in one of the payer manuals that said they still want claims sent to them if they are the secondary payer even if we know they would not pay because there was no CCD left from primary payer. What is your billing practice? If there is no CCD or PR left from how the primary payer processed and paid do you still submit claims to the secondary (whether its commercial or MA)?

Is anyone else having issues with Availity-specifically with UCare?  I have an entire invoice that was never received by UCare and I have verified eligibility, credentialing and everything else I can think of, resubmitted the entire invoice both in entirety and also in several smaller invoices (client by client) and the information is just not reaching UCare.  Also, the interest isn't carrying over on my ERA's, when I actually get them.  So far I have had 4 ERA's this year that were never loaded into Procentive and I am getting frustrated.  A representative at UCare just told me about a clearinghouse called MN E-Connect.  Thoughts?  Suggestions? 

Anyone else missing diagnosis's and admission information for all clients? 

Is anyone else experiencing lagging today? Searching for clients and changing workflow projects are two things that are really moving slowly. I have gotten reports from our providers in different areas, too - so I know it isn't an internet issue.

Chris

Procentive has been informed by the clearinghouse that no ERAs have been received from Unity Healthcare (ID 66705) since February 23. The clearinghouse is working with the payer to resolve the issue and ensure ERAs are delivered. 

We will update this post once the issue has been resolved.

Thank you!

Does anyone know how to enter the Benefit Begin date for Medicare subscribers?  When an eligibility check is run in Procentive, we see the Medicare number and Benefit Begin date at the bottom of each eligibility check.  When adding Medicare to a client profile, there is no Benefit Begin date field to enter this in.  However, there is a "Retirement Date."  Is the Benefit Begin & Retirement Date the same thing?

Thanks!