No Surprises Act and Good Faith Estimate

Jana 2 years ago in Industry News/Discussion updated 2 years 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!


MNCare Tax Audit

John-Debbie Trunk 11 months ago in Industry News/Discussion updated 11 months ago 5

Good morning,

Has anyone experienced a MNCare Tax Audit? What are your insights, are there any PRO reports that might be helpful.

Thank you in advance.



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 6 years ago in Industry News/Discussion updated by sarah 6 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 7 years ago in Industry News/Discussion updated by anonymous 7 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 7 years ago in Industry News/Discussion updated by Suzette Mallum 7 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!


Aetna credentialing

Tammy 4 months ago in Industry News/Discussion updated 4 months ago 5

Can anyone give me any insight into Aetna credentialing as of 2024.  Prior to 1/1/24 Aetna used Pref One for their network credentialing.  As of 1/1/24, Pref One is under United Healthcare.  Because of this all of our providers are now considered out of network according to Aetna and we need to get credentialed directly with Aetna.  In the mean time we have several members with denied claims or claims getting processed as of out of network.  Can anyone confirm this information or give me any insight into what they have done for credentialing with Aetna starting 1/1/24?

Thank you. 


Blue Plus Value 24 Code ONLY on claims?

BillingAS 1 year ago in Industry News/Discussion updated 1 year ago 7

Has anyone else been told that Blue Plus is no longer accepting any HCPCS or Modifiers on SUD residential claims. They said they want ONLY the value 24 code for the intensity and to also send the 1002 room and board code but not the room and board value 24 code on the same claim or they will deny. But I can't get the value 24 code for intensity to send out by itself, Procentive system says to add in a code when I try to add it in the payers module. 

Our Blue Plus rep said to not add the revenue code 0944 or 0945 to the value 24 code for intensity, instead to add that code to the 1002 code but 1002 is a revenue code. And the HCFA example Blue Plus sent shows one and it looks like its connected to the value 24 code? Is any one else dealing with this or gotten it fixed? 


covid testing

Has anyone been able to bill for covid testing in a CLIA Waivered lab? We have clients in our Residential and IOP SUD program that we could do testing in our separate Lab and have nurses who could administer. Has anyone had any luck or found it not possible?