Wondering if something happened because of Christmas, maybe? We usually get around 8 or 9 different remittances from MN-ITS, only got 2 this week. Another organization I contract with also did not get the remittance from MN-ITS through Procentive, either.

This is an important notice specifically for providers who serve patients with TriCare. As you may have heard, TriCare is changing effective Jan 1, 2018.

What does this mean for you and what you do? In order to continue receiving payments from TriCare, the Procentive Customer Care team has identified steps that are important for your organization to complete before January 1, 2018. The exact steps depend on which TriCare Region you bill to. Please be aware you may need to make changes to more than one region.

If you bill to TriCare West:
(Procentive is switching clearinghouses for this payer)

• To start/continue receiving ERAs (electronic remittance advice) into Procentive for TriCare West, please complete this form and fax to TriCare (attn: T2017 West EFT/ERA) at (1-888-282-2841).
• Send the form to Procentive via fax (1-888-354-9053) or upload in a Support Ticket.
• To receive or continue to receive EFTs (electronic funds transfer) from this payer complete the EFT paperwork again.
• Verify with TriCare that you are still credentialed with the correct claims processor. If you are not certain who your claims processor is, please call your Provider Representative at TriCare.

If you bill to TriCare North and/or TriCare South:
(They are merging to become TriCare East)

• To continue submitting claims and receiving payment, enroll for claims submission, ERA and/or EFT by completing the instructions within this document.
• Once the enrollment steps are complete, then notify Procentive (via a Support Ticket). This step is necessary so that Procentive can complete the process on your behalf.
• Verify with TriCare that you are still credentialed with the correct claims processor. If you are not certain who your claims processor is, please call your Provider Representative at TriCare.

Please don't hesitate to contact the Customer Care Team via a Procentive Support Ticket if you have questions.

Is there a Procentive feature that prevents services from being billed before the DA is complete? 

Is it possible to schedule for a PMAP to become inactive at a certain date?  We have a client who has BCBS PMAP through November, but is on straight MA as of 12/01/2017.  We have several service lines to bill in November yet, which will be processed next week.

Since the new payer has been activated for 12/01/2017, is there a setting where I can tell Procentive to deactivate BCBS on 11/30/17 and have MA become active 12/01/2017?  I'm just thinking that this would help eliminate rejected claims by associating new claims to an old payer.

I'm hoping this makes some sense...

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