No Surprises Act and Good Faith Estimate

Jana 4 months ago in Industry News/Discussion updated 2 months ago 8

Hello, is anyone currently using or in the process of creating a Good Faith Estimate for cost of service (as required for the No Surprises Act)?  Just wanting to team up on this if possible so we are not recreating the wheel if someone is already underway with something.   thanks!


A Freebie For Our Mental Health Professionals

I saw this posted today and I hope many of you could utilize this during stressful times like now.

Headspace is offering FREE access for the rest of the year to Health Care Professionals.  It is an app that helps you relieve stress, sleep better, and become more mindful.  Click here to check out the deal.

Hopefully there will be more things that I can post on here to help out our overworked Health Care Professionals.

We here at Procentive appreciate everything you do!


UHC/Optum Claims

TessaLasky 4 years ago in Industry News/Discussion updated by sarah 4 years ago 2


Since the new year all of our claims have come back denied for contractual obligation (code 45). Even on clients that we did not have trouble with previously, we are now having issues with claims coming back this way. Mostly seeing this for code H2014 which is not covered, but we are not getting a denial that we can send to secondary.

I am wondering if there was an update or something that we missed and we are sending our claims to the wrong place? Has anyone heard anything?

If it matters, we preform outpatient mental health services in Minnesota.

We have had a nightmare of a time dealing with United Healthcare and the Optum side. Being one is behavioral health and the other is the actual insurance plan, you would think they communicate with each other.

Thanks in advance!


Medical Assistance Mental Health Copay Write off?

Good Afternoon everyone! I've been getting the run around, so I'm hoping someone has some advice.

I bill for a mental health facility in Minnesota. While looking online at our MN DHS website, I found a few different documents staying there are no copays for mental health visits. 

I contacted the state, and the rep I talked with said that we are supposed to write off copays and deductibles for patients with MA or a PMAP. Spend downs not included. 

This has put a lot of discussion into our office lately. 

Has anyone heard of this? These patients' claims are being sent and coming back with a Patient Responsiblility, so I would assume that if they had no copay, they wouldn't use a PR reasoning code.

Any info is appreciated! 

Thank you!



Sheryl Martin 5 years ago in Industry News/Discussion updated by anonymous 5 years ago 9

Can anyone share what system/program you are using for telehealth appointments?  Pros, cons?  Thank you in advance!



MN CTSS agencies - unannounced site visit questions

Jana 5 years ago in Industry News/Discussion updated by Suzette Mallum 5 years ago 4

For any of you who are MN CTSS providers -

1. Has anyone had an unannounced site visit?

2. If you have more than one CTSS location, is each site individually certified for CTSS svcs?

3. For your Disclosure of Ownership form, who do you have listed as having "ownership" in your organization?  (Board of Directors, President/CEO, supervisors, etc.)

4. Is everyone aware there is a state-approved interpreter list and only those interpreters are reimbursable by state funds?

Thanks in advance for your input!


Gender neutral wording in Procentive docs

Kim Ross 2 months ago in Industry News/Discussion updated by Laura Anderson 1 month ago 1

How is everyone making sure clinical documents, intake paperwork, treatment plan templates, Therascribe, and other Procentive content is gender neutral?

For example, we use Therascribe, and the treatment plans used with in Therascribe use he/she. 

Thanks all!



HealthPartners OP SUD billing - Each staff has its own NPI?

BillingAS 6 months ago in Industry News/Discussion updated by sarah 6 months ago 5

We have been told by HealthPartners that in order for our facility to re-credential with them that each staff member at our outpatient SUD facility has to be credentialed and have their own NPI and that there is no way around this. Each staff member would also have to apply through the HP portal and give all their employment history, DOB, SSN etc. I informed our rep that we bill by the facility under one NPI. She referred me to a section on HealthPartners portal that does say that LADC must be credentialed but I still don't believe this is right. We have been credentialed with them since before my time and all of our HP PMAP and commercial claims continue to get paid even though we are not enrolled this way. Any one else run into this issue? If so how were you able to fix it? 


Implementation of CURES ACT

As of 4/5/21 with mandate to be in place by the end of 2022 Sounds to me like our progress notes must be made avaialbe free of charge and immediately to all clients. There is reference to clients needing to have access to an app that can be downloaded to their smart phone (or other device) where they can read their progress notes (psychotherpy notes still protected) with specific detail of what needs to be in each one on the article I attached below amd must be avaialbe immediately to each client.

I am wondering if the Client Portal is sufficient to manage this request or if Pro is planning to do more to align with CURES ACT?