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?
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!
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 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?
Insurance termed so I posted the takeback to the clients account. What exactly are the next steps that I need to do so I can rebill this to secondary ins for the full amount of the claim???
Buckle up, this is a deep dive.
To understand the nature of the question, it is important to first understand that when my organization sends claims, each day usually has more than one service line for the same code, because clients attend more than one "group" in one day and the services are billed separately. So as a result, we have multiple service lines, for the same client, on the same day, with the same code.
When posting payments, my organization requires payments to be applied in proportion to the number of units to which that payment is being applied.
With this in mind, I am trying to find a way to prevent Procentive the following universal problems:
—Automatically adjusting off money that I want to leave as a balance
—Applying co-pays more than once on treatment days where we bill 2 separate "chunks" of time rather than all units on a single service line
—Improperly allocating funds respective to unit counts (This is my biggest issue with procentive overall. see below)
When, for example, the allowed amount (B6) is 50% of what was submitted, The claim is sent as 3 units and 1 unit of the same code, but the remit bundles these into one lump sum for 4 units. So, Procentive will:
-Put all the money on the line with 3 units
-Adjust the remaining balance
-Adjust 100% of the remaining 1 unit.
In this scenario, I need to manually tab through every field in payment entry mode to ensure that 3/4 of what was paid goes on the line with 3 units, and 1/4 goes to the line with 1 unit. The only time Procentive gets this right is when B6=100% of submitted charges. Adjustments, specifically, are causing the imbalance.
(Using the "allocate payment" dialog is not a viable solution, it only works when [B6=100%] OR [there is only 1 CAS code AND all claims paid are in a contiguous time span AND only one client account is being paid on the remit.])
I don't know if this is something that can be fixed on the user end (I have tried messing around with the "rules" for the payment entry mode, and while useful for other tasks, I could not solve any of these problems using them, or any other settings within procentive.) This is a major time drain when payment posting, especially when there are copay/coinsurance/deductible involved. To speed things up I usually just apply the copay to one line where possible, but the payment per unit rule is not something I can do differently.
Am I overlooking something that I could be utilizing? Can systems engineers write new code to address this? Do we need to change our billing process entirely if we want to avoid this problem? I have been trying to find a solution to this for over a year and I am completely stumped.
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