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UCare ERA's & Payments

Nate Kalkwarf 4 years ago in Payments/ERA Modules 0

Has anyone noticed unusual delays in payment processing and ERA's from UCare in recent weeks? 

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Non payment from Blue Plus plan - Restricted Recipient Program ???

sfoster 5 years ago in Payments/ERA Modules updated 5 years ago 2

Has anyone else seen denied claims from BCBS pmap (LMN... policy) and been told it is because the member is in a Restricted Recipient Program? 

This note is from MNits regarding this type of policy/program:

Restricted Recipient Program:

Some MHCP recipients are required to receive the following services from specific providers: Inpatient Hospital, Pharmacy, Physician Services, Mental Health, Outpatient.

The frustrating thing is that you do not know the member has this "restriction" unless you actually call BCBS or first check Availity and then check MNits. It is NOT indicated on Availity at all. So when a client gives you their BCBS pmap card and you check Availity for active coverage, you then have look at the image of the card to get their MA #, then login to MNits to see if they have this type of program. 

Also, the BCBS rep told me authorization is NOT an option for this type of program and our only option for possible payment would be to appeal for medical necessity. 

Help anyone! Thanks, Sara

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Billing CCDTF (Rule 25) as a Secondary Payer

Jeremy Roelofs-Lynch 5 years ago in Payments/ERA Modules updated 5 years ago 4

We bill R25-CCDTF as secondary for qualifying clients. I have noticed that I am updating the COB and it leaves our clearing house correctly but in MNITS and on our ERA from MN DHS they are paying the full (original) rate...

Currently I go out and update the rates in MNITS via a replacement claim. I have a call in to them but wanted to see if anyone else has come across this???

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Blue Plus of MN reimbursements

Is anyone getting reimbursed the full amount billed for 90837?

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7/10/19 Ucare remit

Is anyone else having any luck bringing up remits in Ucare?  I am unable to bring up yesterdays remit on Ucare's site.

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ERA- Loading Time

Valerie McNamara 5 years ago in Payments/ERA Modules updated by Laura Hulsey 5 years ago 1

Is anyone else experiencing slow ERA loading time since the update? Some of our ERA's take from 3-5 Minutes to load (this is a very large ERA).  Is anyone else experiencing this? 

We have also been noticing slow time on Payments module as well....

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bcbs pmap

amybenson 5 years ago in Payments/ERA Modules updated by Shauna Dall 5 years ago 8

Is anyone else still receiving a short pay on claims from BCBS PMAP? I bill for H2012 UA HK and the DHS rate for 1 hour is $65.26. BCBS PMAP prior to January 2019 paid $67.21 a hour. Now I am receiving $32.39/$32.38 a hour across the board. I have asked for "Project" to be opened to capture my incorrectly paid claims and have not been successful with customer service at Amerigroup. Our Provider Rep doesn't respond back to any emails or phone calls. Any advice or what is everyone else doing?

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ERA - MN-ITS - Modifier

Hello, we have recently starting billing using the UC modifier (UC = HH + U5) for Complex Medical Services. 

We are getting service agreements approved with the new Modifier even for our MICD clients. This way we can always under bill or have prior approval if the client upgrades their treatment from MICD to Complex/Co-occurring. 


We were told that since UC is a combiniation that include HH if we bill the HH rate they will only pay that. My question is when we look at the MN-ITS website we see they are paying the MICD rate; however, it shows the UC modifier still. Does it matter if the Modifier on the ERA does not match the treatment exactly. Again, they pay the correct rate. 


Just seems a bit weird to me. 


Thank you :)

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Credit Card Processing through Procentive

Paula 5 years ago in Payments/ERA Modules 0

I just love the feature of processing credit cards through Procentive with CMS.  The process is SO quick and smooth,  If you have been thinking about transitioning, I would encourage you to do it!  It will be worth it!