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BCBS PMAP Claims Processing incorrectly

donna monahan 5 years ago in Payments/ERA Modules updated by sadie twite 5 years ago 1

Anyone else having issues with denials from BCBS PMAP through Amerigroup on Outpatient treatment denying when billing for multiple sessions? We have been having a lot of issues with this new BCBS PMAP Amerigroup arrangement.

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Preferred One payments

Valerie1 5 years ago in Payments/ERA Modules updated by Jen C 5 years ago 5

Is anyone else getting double or even triple payments coming in from Preferred One?

Answer
Amanda Kaufmann 5 years ago

Hello, 

Here is the communication Procentive received recently from our partners at the clearing houses regarding Preferred One ERAs. 

"Preferred One distributed some old remittance data on May 9th (2019). These remittance files were distributed to our trading partners because they were NOT duplicates of previously processed remittance files. Preferred One notified the clearing houses at approximately 12 noon today of their processing error. Unfortunately the files were processed and distributed to our trading partners the same day that they were received."


Although Preferred One states that these are not duplicates, what we have been able to uncover is that they're not duplicate File Names and Check Numbers, therefore resulting in possible duplicates in our system. 

One way to check to see if this has already been paid is to check to see if this is an old check date, as well as if this has already been posted a posted payment in the system (seeing the yellow can't use field, or clicking the payments link to see if there is a posted payment)

If it is a confirmed duplicate payment please manually mark the ERA as Processed, and do not save the payment in to Procentive. If you have saved the payment, simply access the payments module and delete the payment. 

Please submit a Support Ticket to Procentive if you have any additional questions. 

Thank you,

Amanda Kaufmann

Customer Success Manager

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R45-R45.89 diagnostic codes

tbelcher 5 years ago in Payments/ERA Modules updated by sarah 5 years ago 1

Has anyone submitted them to a PMAP yet?  I'm submitting some test claims to see what happens.  Is is always comforting to know that PMAPs don't know what diagnoses work with your systems.  They just respond to denials.

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Denials from BCBS PMAP

ahaugen 5 years ago in Payments/ERA Modules updated by Kayla Kenworthy 5 years ago 69

Is anyone else having issues with many denials on recent BCBS PMAP payments due to the "197" code.  Will pay the 9 code, but deny the travel due to the "197" code. Or won't pay on either code due to the "197" code. 

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Has anyone else received two ERA's from DHS this week?

KELLY PERFETTI 5 years ago in Payments/ERA Modules updated by Valerie1 5 years ago 3
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Has anyone received their BCBS ERA's over the weekend?

Tina B 5 years ago in Payments/ERA Modules updated by Leah T. 5 years ago 7

We usually have at least 10 ERAs from BCBS that come in over the weekend. We did not receive any.

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Medicare - New Testing Codes

natale 5 years ago in Payments/ERA Modules 0

Has anyone been paid for the new testing codes from Medicare?  We keep getting a denial that says "no referring provider listed."  Thanks in advance for your help. 

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BCBS

Mardi 5 years ago in Payments/ERA Modules updated by Valerie1 5 years ago 103

Has anyone received payment for services in 2019 from BCBS Blue Plus?

Answer
Alicia Swanson 5 years ago

There has been much back and fourth on this thread of what everyone is hearing and expressing frustration.  We understand the extremely difficult circumstance you are in and we have been invested in seeking truth with facts on this situation and here is what we have found:

  • - We have had several agencies receive an ERA from Blue Plus (00562) although only professional claims at this point in very small dollar amounts. The ERA payer column will read “BLUE PLUS OF MINNESOTA”
  • - 1/3rd of those agencies have confirmed (we called them) they had an ACH payment into their bank for the exact amount on the ERA. At the top of the ERA when opened, the Method will read ACH.
  • - The agencies who received these EFT/ACH payments DID NOT do anything extra or different with registration, re-processing, etc.


Blue Plus has contracted Amerigroup Health Solutions to process these claims.  Amerigroup is required to abide by the terms from Blue Plus which means you DO NOT need to register, or re-process claims.  If you had ERAs and/or EFT set up before the change it will continue moving forward- no further action required. Blue Plus is aware some agencies have been told they will get a paper check mailed to them but that was an error and should not continue to happen.

We are continuing to run reports daily to track agencies getting ERAs and hope to see this number continue to rise.  We will continue to post updates as we see other improvement. 

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Thanks

Print Receipt Checkbox

Mark Cornell 5 years ago in Payments/ERA Modules updated by Ashley M 5 years ago 1

Thanks for adding the Print Receipt checkbox on the payment entry screen!! 

It was so annoying to have it pop up every time :)

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Has anyone received denials from Blue Plus PMAP for 2019 dates for an authorization?

Tina B 5 years ago in Payments/ERA Modules updated by Karen H 5 years ago 23

I received denials for 90791-90834-90837 and our group and IOP codes for an auth. I checked on the BCBS provider site and at first it appears behavioral health may need an auth, but non of the codes are on the prior authorization list.

Thanks....Tina

Answer
Amanda Kaufmann 5 years ago

Hi Tina, 

Information will be going up on our new "Updates" page regarding this. We have a fix in place, as we were made aware of this issue this morning. 

Please stay tuned, the update will be posted shortly. 

Thank you, 

Amanda