Our facility has never billed secondary payers. I am trying to get this set up but seem to be struggling.

Can anyone share best practices, tips/tricks, workflows, lessons learned...?

Do you bill the secondary when you are posting the ERA/Payment via the ERA Module?

Do you do everything manual in the COB Tab?

Is anyone currently billing or had any success in billing for assessments such as the PHQ, GAD, etc?

This is a sticky situation, but does this happen to any other agency, and how do you direct/navigate the guarantor to resolve these issues?

Client is a minor whose primary insurance is through biological father, secondary insurance is through MN Medical Assistance.  The primary insurance through biological father lapsed, and we’re told there is no way to contact biological father to verify primary benefits or inquire.  If we send the claim to MN Medical Assistance, they will deny because they have biological father’s insurance on file as a Primary.  Feels like we are stuck.  How do you get the wheels moving forward on this?

Does anyone know if it is possible to bypass a primary payer that does not except our codes when the client has a secondary payer that does except them? I.e. Modifier? 

NOTE - primary is NOT Medicare or a Medicare Product. (We use GY)

We are new to Procentive and I have a couple issues I could use help with. The first one is I am having trouble with rejections from Hennepin Health ,first on was about service codes fixed that resubmitted now the rejection is "service line days" looked at the X-12 summery and claims looked good! Anyone have any insight? Next pertains to BCBS Private claim we as a company do 96% consolidated and Pmaps, when I submitted BCBS paid one day on both claims called them and they said for Private I should not send HPCS  or modifers on a Private claim. does not seem correct to me. Would appreciate any help

We are new to procentive and I have two issues. First I am having trouble getting clients with Hennepin Health out of the module had an rejections on Unit codes fixed that now they rejected because of "service line days" looked on the X-12 summery and claims looked good. Any insight out there? Second issue is I cannot get a Private BCBS claim to pay at our private rate,called BCBS and they said that I cannot put HPCS codes and modifiers on a Private claim only on a Pmap,does not seem correct to me.95% of our clients are consolidated or Pmap so this does not come up often. I greatly appreciate any help.

We are wondering if any clinic has ever billed Medicare IOP(Intensive Outpatient Program) services, if so what code?  Any information would be helpful.

We are attempting to bill an IFB (Individual & Family Business) plan that requires the referring provider on the claim. I am having trouble getting this populated. 

Where is this pulled from in Procentive?

Any help is appreciated! 

JRL

How involved in the Medicare application process?  Our agency is not currently set up as a Medicare provider, but need to move forward on applying.  I'd appreciate your thoughts on how time-consuming the application process is from start to finish.