Blue Plus Payments

Paula 3 years ago in Payments/ERA Modules updated by sarah 3 years ago 65

Is anyone else experiencing Blue Plus paying less (over $40 less) per each 90837.  It looks like this started around July 1st?  I called Blue Plus, the Rep was unaware of any fee schedule changes and he submitted a ticket to have it get looked at.  Since then, I have had two other mental health clinics in our area report that they are also receiving a lower payment. Is this affecting anyone else?


Denials from BCBS PMAP for Clinical Documentation?

vpetrik 1 year ago in Payments/ERA Modules updated by sarah 1 year ago 1


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!


Suggestion for ERA payment entry recording

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.


report mode in new window while posting ERAs

Kim N 3 years ago in Payments/ERA Modules updated by KatieW 3 years ago 2

Loving the new option of looking at Report Mode in new window while payment entry mode is still up !!!!


Primary EOB's

TessaLasky 3 years ago in Payments/ERA Modules updated by Ashley Kallod 3 years ago 4

I am wondering if anyone else is having issues with the primary EOB information being sent along with claims? I have noticed with our Wilson McShane (BCBS) claims and some of our UCare PMAP claims, we send it to secondary with the primary payment information added into the "COB" tab in Procentive and they still come back denied. For many of the claims I have to fax in paper copies of the EOB's otherwise the secondary insurance cannot see it any they deny. Any suggestions?


UCare denials - authorization

Good morning!  Curious to know if other facilities have recently seen UCare denying claims with the CO-197 denial code (authorization) for claims you sent that had the authorization number attached and the auth was valid?  The two facilities I bill for, I've seen this happen with several clients on the past couple of remits, so trying to gauge if this might be a more global issue with them right now.


Aetna processing as if secondary to Medicare

Tina B 2 weeks ago in Payments/ERA Modules updated 2 weeks ago 2

Wondering if anyone has ever come up against this.  Client has Part A Medicare, no Part B.  Client was in IOP and Aetna has processed claims as if Medicare is primary and adjusting off most of the charge. Aetna is telling us this is a penalty since the client declined Part B Medicare. I don't see how they can do this. They are penalizing us, not the member.



Hennepin Health (HH) ERA Adjustments?

Jeremy Roelofs-Lynch 1 month ago in Payments/ERA Modules updated 6 days ago 11

Hello, we have noticed that over the last few weeks our HH ERAs are coming with a bunch of adjustments; even though they paid the full amount. It is causing me to go in and manually change all the lines before saving it. 

I am curious if anyone else has seen this?


BCBS Blue Plus Assessements

Jeremy Roelofs-Lynch 1 month ago in Payments/ERA Modules updated by Kim Ross 1 month ago 6

BCBS posted a Provider Bulliten on 4/10/2019 stating that as of 5/1/2019 we should bill the R25 Assessment with the HF Modifier to distinguuish between it and the Comprehensive Assessment. 

Yesterday we received two ERAs for DOS January - April 2019 where they reprocessed ALL of our R25's as Comps since they were billed with no HF Modifier. The communication I have clearly states it went into effect on 5/1/2019. We get paid more for our R25 so it is resulting in a large takeback.




ERA import delay

Valerie McNamara 1 month ago in Payments/ERA Modules updated by Chris Werner (Customer Success Manager) 1 month ago 7

Has anyone else noticed a delay in how long it takes to see ERAs from MN-ITS in Procentive?  There has has always been some lag, however we don't have our yet.  It looks like the files are available in MN-ITS as of 9/13 but not into Procentive yet....