Hi Everyone,

I am wondering how you all are handling this transition of new Optum payers that have been added so that we can send the U5 modifier with the DQ qualifier for our clinical trainees. Specifically, if you have a clinical trainee and a licensed provider seeing the same client with one of the payers that procentive split so clinical trainee and licensed people are billing different payers in procentive.

Any feedback on this change would be appreciated! 

Effective December, Medicare and plans are denying any F43 code (F43.1, F43.23 etc). 

The most recent MA remit is showing a denial remark code N21 “your line item has been separated into multiple lines to expedite handing”. I understand what’s going on, but DHS says its an issue on our end, and I believe its on issue on their end. This started to

Are any of you billing 90 Degree Benefits for your clients? On the 90 Degree website it says "If you send EDI claims to Change Healthcare, please update the platform to Optum Healthcare." We reached out to Procentive who told us they only use Availity for electronic submissions and there is not an option to use a different clearing house. What are others doing in this situation? It seems to me like we shouldn't have to submit paper claims. 

For those Procentive users that switched to Vantage, do any of you use Card Swipes by chance?  If you do, are you having any issues with them not pulling in the correct information?   

We were informed by Procentive that any generic card swipe would work and we used them with CMS with no issues.  But now that we switched to Vantage and use the card swipes, it pulls in the cc number but puts symbols in the front of the number and then cuts off the end of the number because of the symbols being entered at the beginning.  It also does not pull the expiration date or security code in.  

So just wondering if others are having this same issue, or if it is just something on our end for some reason.  We have a ticket in to Procentive about it but no resolution yet from them either. 

Procentive- Has this issue with DHS and Availity Claims been resolved?  I do not want to have my staff resend all our claims if there is still an issue. 

To make sure before billing that there isn't just 'a note' but that there is a signed note.

Has anyone run across this:   All of my Residential SUD Claims started rejecting.  This is the error I receive: 

rror Initiator: HIPAA Message Type: R
Error Code: 0x3938be0
Error Message: Segment HI (Value Information) is used. New instance of segment H
I should not be used when previous one has not been filled out. Segment HI is defined in
the guideline at position 2310. Invalid data: HI*BE:24:::82260

I have changed nothing and received payments previously.   I called Availity and was told it had something to do with Procentive and how they were submitting the submitter.   I submitted a ticket to Procentive and have been waiting for this to be resolved. 

Anyone else run into something like this and if so what options might I have.   Thanks.

Has anyone started having troubles in the past week or two that there claims are denying on MNits for 132 and 153? I've been calling nonstop to DHS but always get the message that there is too high of a call volume and get hung up on. We are billing SUD IOP and its happening to all of the codes, H2035, H2035 HQ, H0038 U8 and T1016 U8 HN. Anyone have any insight on this or gotten through to them? We have four locations and its happening to all four so I think there is something bigger going on that's effecting all the claims.