Has any SUD providers figured out how to bill with the Value code for Blue plus claims since they want us to stop using the HCPC code/combination effective 5.1.22. They say they do not want to see any HCPC for the TX line they want a value code to be billed. Only 1 value code can be billed on a claim and I am billing with that for the room and board part of the claim. I have asked my Provider contact person with no help.

Also since i turned on the Value code option on my payers BCBS pmap and UCARE the claims deny for use of said Value code. Procentive wont let it out the door. What a mess....

Hello,

Currently procentive seems to "force" an attending provider to be noted on our UB04 forms so we chose our Presidents info a while back for this. However, technically under SUD all the LADC's are housed our our facility itself and we are billing a day rate bill out. 

I am wondering how others were able to by pass this requirement on procentive in order to bill  ? 

Thanks!

I sent out claims electronically on Friday and when I went to the Electronic Module this morning claims are still in "sent" status versus received.  Im not sure if there was any updates that were made in Procentive that these electronic claims have not been received yet. I also had no ERAs this morning which is odd for a Monday morning.  Is this a clearinghouse issue?

Hello - We are in the very early stages of opening a Withdrawal Management line of business. Does anyone use Procentive for clinical charting and billing? Thoughts?

I have always worked with 245G SUD services so this is new for me. - Thank you JRL

In the near future, we are hoping to add a Nurse Practioner to our facility, we are Residential Treatment for Adolescents Co-occuring.

  Our biggest hurdles are: 

1. how do we bill for her services,   Rev code, procedure code, etc.

2. Do we need to be credentialed by the insurance companies to add this service for billing?

3. We bill UB-04 can we bill for her services on a UB or do we need to use the 1400/1500

Hello

I am wondering how other agencies deal with COB denials.  I have some claims pending due to requesting COB information from the policy holder for different payers. What is your process for these types of denials? Ive thought of sending the client a bill for the amount due. Any advice is welcomed1 Thanks

Just wanted to give everyone a heads up to check your Blue plus  and Prime West claims prior to sending. Look on the actually HCFA forms once you scrub /check them  --- it is splitting room and board onto an entire different claim as treatment line. 

This is going to cause things to deny and dupes, deny as a whole because they are not in the format BCBS wants and they are picky on their requirement and potentially PW too. 

We have had a crisis ticket in for 2 weeks now with no fix from Procentive and over 200,000 we can't bill for. If yours are doing the same please submit a ticket as well. This is detrimental to businesses and needs to be fixed.

They seem to think its associate it with the value code option being added to the payer, but it doesn't matter if we use the value code or don't use it it will not send combined correctly.  They say they are not abruptly changing anything cause it could cause issues with other claims being sent without the value code. But again.... either way is NOT sending correctly. So something needs to be "tried"

They fixed UCare weeks ago for the same issues. 

I assume we are all having this issue but maybe just not all aware of it yet. 

Comment below if you are too? 

Jenna

Hello- Looking for input or to see if anyone else is having issues? 

UCARE has been processing 2022 Withdrawal Management claims incorrectly.  We received communication that the billing provider address is not contracted for Withdrawal Management.  Technically not wrong- the Line 2010 Billing provider is our main office.  Also on the claim though is line 2310- the service facility location that is contracted.  We are being told that the billing location has to be the service facility location.  The odd thing is that all claims for all payers go out with the same address set up and no issues with other payers, only UCARE.  Another point I do not understand is we offer several different services at several locations and those are processing correctly.

Ucare is telling us that they are not seeing a service location on our claims. They say they have been manually correcting this but will no longer be doing this going forward. The problem is that we can see the service location on our UB-04 forms when we send out a claim. Has anyone else heard of this and how did you correct it?

We are looking into modifying our billing practice to bill three separate groups (same patients in each group) in one day and having difficulty getting paid using code H2035HQ.   Is there a different modifier we shoud be using?  Not sure what we are missing? Please help!