bcbs pmap
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?
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 :)
Credit Card Processing through Procentive
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!
BCBS PMAP Claims Processing incorrectly
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.
Preferred One payments
Is anyone else getting double or even triple payments coming in from Preferred One?
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
R45-R45.89 diagnostic codes
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.
Denials from BCBS PMAP
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.
Has anyone received their BCBS ERA's over the weekend?
We usually have at least 10 ERAs from BCBS that come in over the weekend. We did not receive any.
Medicare - New Testing Codes
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.
Customer support service by UserEcho
