Hello,

I'm curious. My boss said we used to have Procentive track the number of units left for certain codes for patients.

Ex: We can bill 20 units of 90837 per year...this feature would track how many are used and give us a heads up if they were running out.

The only thing I've seen is the Benefits part which will show how many units are available for service with an authorization. Is this the only one or does my boss know of a magical new thing I should be utilizing?

Last Tuesday there was coding related to an improvement to billing functionality that went through that triggered some claims to come back with an error from the clearing house.   The error has been resolved on our end but claims sent Tuesday or Wednesday will need to be resubmitted.

Because of this we are making the following recommendations:

1.  Review your Electronic Module for error-ed invoices that were sent on Tuesday or Wednesday and review the error reports.

2.  The error is located in the H1 segment.  If you find an error there, then the claim needs to be resubmitted.  The error on our side has been resolved and the claim will go through without the error impacting the claim again.

3.  Contact Procentive Support via the Ticketing Module if you have questions or concerns.

Has anyone lately had trouble getting their new contracted rates updated in UBH's system.  We have a contract effective 8/1/2017 and our claims still are not being paid correctly

We keep getting rejects with the following wording, wondering what others have done because it seems to stop them from ever getting to the payer, but doesnt really say whats wrong?

 Category: Acknowledgement/Returned as unprocessable claim  The Cl
aim/Encounter has been rejected and has not been entered into the adjudication system St
atus: Processed according to contract provisions (Contract refers to provisions that exi
st between the Health Plan and a Provider of Health Care Services)

Good Morning Community,

I've recently run into remits in the Pro-ERA Module where the insurance payer will not pay anything on the DOS and will filter the allowed amount to 187, which is a health savings account designation. 

How do you manage this? Do we wait for the HSA pmt to come in? Any support is appreciated. Thank you in advance. 

Debbie

Good Morning,

Recently we've been noticing some service lines being sent to the payer without an audit ready note, or no note at all. Is this a glitch in procentive or are we doing something wrong? It seems to happen randomly. Any ideas on how to make sure that this doesn't happen? We are newer to this system so any "easy" walkthrough answers are appreciated.

Thank you!

Hello -

As it is so difficult to get someone on the phon at Medicare, I thought I would post here to see if anyone else has experienced this issue.  We have had issues with billing for substance use disorder services in the last few months with PMAP policies that are secondary to Medicare.  What most recently happended is that the client didn't inform us of a primary Medicare policy, and we found out about it after getting claim denials from the secondary BCBS MN PMAP policy.

Here is the issue:  our facility and providers are not Medicare eligible - in fact in the past Medicare has told us that we cannot send claims to them; Medicare stated that patients would need pay us directly for services, and then send claims to Medicare themselves in order to get reimursed.

I'm at a loss at this point as to how to proceed with secondary claims to BCBS MN - I can't get a denial as I can't send claims, and BCBS MN won't pay without COB information.  

Any advice?!

Hello!

I have an ERA  that shows no amount paid, but when I open the claim, it was that $41.60 is paid. I have the blue dotted box with multiple listings in it...for example:

WO>20170405 PR(Claim number here)   $Amount

I know sometimes these are used for interest, but what does the WO mean and how can I pay the claim without having this ERA overallocated?

Hi Everyone!

Many times, I will be working on a MN DHS ERA and the payer changes to Medicare (or vice versa). I will start to allocate the ERA and then I notice that the payer is wrong, but I can't change it. If there are takebacks, I am unable to finish allocating due to the payer being incorrect. Is there any easy restart button to change this? Or do I have to manually go into the ERA and delete every single payment for customers through the Payment Module? 

Please help!

Has anybody had success voiding claims for BCBS? Seems that I am doing something wrong. I am filling out the control number, etc. but got a message from BCBS stating the header information does not match the predecessor. I wonder if I am missing something?