I haven't seen that our ERA from DHS come in.  Does anyone know if there is a delay?

Does anyone have a solution to billing claims for LPC for individuals with Medicare as Primary?  I have an individual who wants to see our LPC, but has Medicare as the Primary insurance.  BCBS is secondary and they are denying claims stating it needs to be sent with EOB information from Primary.   What is the best way to get this claims processed by BCBS?

We were finally able to successfully bill the enhanced rates on our room and board line. It has always been on the grid rate sheet but we never were able to get it through. We billed enhanced rate with with child (U6) and medical (U5). After a few phone calls with DHS and asking the right questions we were able to bill directly on the MN-its website and get paid. 

Now when setting up our current clients with the room and board plus modifiers in Procentive it cannot clear their system. They say that DHS has been made aware of the issue that when sending in batch form it will not clear a revenue code with modifiers. Only a CPT code with modifiers. 

They also said that most people (like us before) just end up getting paid the base rate. So to test it out first. If entered right on MNit's you can get paid for this. It is a substantial amount of money over the course of a year billing out these rates. 

We are wondering who else is having this issue and if enough of us raise and issue with Procentive /DHS  the proper changes can be made so we can bill out of Procentive without having to go into MN'its directly to edit and bill the Room and Board w/ mods for every client in the facility. 

Does anyone else have a process through Procentive set up for combining multiple practitioner's claims for CD services on one UB claim per day?  BCBS is requiring this.

How does Procentive arrive at the various column figures of Collected vs Basis.  The difference doesn't appear to be obvious.

I know the DA needs to be dated the date it is complete and signed. Has anybody heard that this is required for ALL services rendered to MA clients?

Hello,

Has anyone experienced delays in receiving their ERAs from MN-ITS in Procentive? We generally receive ours on Sunday or Monday of the payment week, but still have yet to receive them this week.

Chris

I am trying to get some information/clarity around using the U5 Modifier when billing out H2035. 

1. Does anyone else bill using this modifier?
2. Can anyone explain this Modifier to me? I am not having much luck on the old google machine!

Thank you

We are not a medicare facility. We are wondering if anyone has successfully billed out CCDTF funding from the county when given service authorization if a patient has medicare primary? The counties are saying it "overrides" if they are giving a service authorization but we are getting a kick back due to other payer.  

 It appears that when I use an HN modifier for BCBS (Amerigroup for medicaid clients) claims are incorrectly paying as if we are a Rule 29 clinic (physician's rate of pay).  How do I identify a supervised clinician if I can't use the HN modifier?