I work at an adolescent inpatient treatment facility and occasionally we admit clients who are 18 or turn 18 during their treatment stay.  This year Ucare pmap are paying a reduced rate after their birthday however they are receiving the same services which includes high school services.  Has anyone else experienced this?  The rate is being reduced from 216.34 to 179.25.   

Does anyone know what facility type code we should use for drug testing codes such as 80305 & 80307. I've been using code 89 but one payer is denying our claims because it's the wrong facility code type. They won't tell me what code they want us to use and they just said to talk to our biller. I am the biller and I've not been able to find this information. If anyone can assist please reply. We do drug test lab screenings at our facility. Thanks.

Hi,

We are submitting for CLIA waived UA testing. The claims are denying as the Certificate # needs to be on the claim.

Does anyone know where this Cert # is to be entered in the payer, code or on the claims? We do not receive auths for this service.

Thanks for your help, Teri

Questions for billing Interpreter services to a p-map for CD services: 

Do we enter one individual session for the whole day the interpreter was here?

Who do we use for staff? 

Thank you for any help you can offer.

Has anyone had any success with billing Veterans Affairs for SUD residential services or SUD outpatient services through Procentive or through their portal? We are getting rejections from the clearinghouse for services billed through Procentive and denials about dates overlapping in their portal which doesn't make sense.

Question about the functionality of the Diagnosis tab as it relates to Inpatient (Residential calendar) billing.  The Diagnosis tab on the Change Client window has the capacity to record detailed, extensive patient diagnosis history, but when it comes to billing inpatient/residential claims through the residential calendar in the time module, all the distinctions from that tab are lost - it seems the full history is pulled in to the claim, regardless of program, date, or status.  Is there a way to use the full capacity of this tab and not have most/all (including duplicates) pull into the claim?

We received information from Availity stating there may have been an issue with some ERAs from Anthem recently,

Please go to our Live Updates page for more information.

Thank you!

At times, we have clients who return to services with a previously unpaid CCD.  (We don't send past due accounts to collections.)  

In this particular case, the CCD is a result of a termed MA PMAP, after which the clinician continued to provide services. Balance owing is close to $1000. (We were hoping for a retro so didn't suspend services...)

Now the client returns having once again obtained an active MA PMAP plan.

What would you do in this situation? 

Does anyone know if a patient has MA or a PMAP as a secondary and their commercial primary denies for timely filing how I can send to secondary to receive payment?

I just got off the phone with a commercial insurance plan as I was checking on denied claims for a patient. This patient has MA has a secondary. The commercial primary is denying due to the COB box on the electronic claim was checked yes. Commercial insurance rep told me that if a patient has Medicaid/Medicare that box can't be checked yes. Can someone please help explain this to me and why? Where is that box in Procentive? I have numerous denied claims for numerous patients with this same issue?

THANK YOU!