Good Morning,

Recently we've been noticing some service lines being sent to the payer without an audit ready note, or no note at all. Is this a glitch in procentive or are we doing something wrong? It seems to happen randomly. Any ideas on how to make sure that this doesn't happen? We are newer to this system so any "easy" walkthrough answers are appreciated.

Thank you!

Hello -

As it is so difficult to get someone on the phon at Medicare, I thought I would post here to see if anyone else has experienced this issue.  We have had issues with billing for substance use disorder services in the last few months with PMAP policies that are secondary to Medicare.  What most recently happended is that the client didn't inform us of a primary Medicare policy, and we found out about it after getting claim denials from the secondary BCBS MN PMAP policy.

Here is the issue:  our facility and providers are not Medicare eligible - in fact in the past Medicare has told us that we cannot send claims to them; Medicare stated that patients would need pay us directly for services, and then send claims to Medicare themselves in order to get reimursed.

I'm at a loss at this point as to how to proceed with secondary claims to BCBS MN - I can't get a denial as I can't send claims, and BCBS MN won't pay without COB information.  

Any advice?!

Hello!

I have an ERA  that shows no amount paid, but when I open the claim, it was that $41.60 is paid. I have the blue dotted box with multiple listings in it...for example:

WO>20170405 PR(Claim number here)   $Amount

I know sometimes these are used for interest, but what does the WO mean and how can I pay the claim without having this ERA overallocated?

Hi Everyone!

Many times, I will be working on a MN DHS ERA and the payer changes to Medicare (or vice versa). I will start to allocate the ERA and then I notice that the payer is wrong, but I can't change it. If there are takebacks, I am unable to finish allocating due to the payer being incorrect. Is there any easy restart button to change this? Or do I have to manually go into the ERA and delete every single payment for customers through the Payment Module? 

Please help!

Has anybody had success voiding claims for BCBS? Seems that I am doing something wrong. I am filling out the control number, etc. but got a message from BCBS stating the header information does not match the predecessor. I wonder if I am missing something?

Is anyone else having an issue with Eligibility?   We keep getting a clearinghouse error after it has ran from DHS.

I received a letter, this week, from DHS stating that they have not received any claims, for the past 12 months, for one of my locations, so they are terminating the enrollment for that location.  I bill weekly to DHS  for this location.  After lengthy phone calls and wait times, DHS is suggesting that the Procentive Billing Provider Loop 2010AA, Segment NMI, N3 and N4 need to be listed as the location of service and not our Central Billing location address... has anyone else received one of these letters and if so, what did you do about it?  

I was wondering if any providers have ran into issues with billing when the diagnosis of a substance abuse disorder was listed.  I know it cannot be listed as a primary diagnosis. I would think as long as it is not a primary diagnosis, it shouldn't impact reimbursement.  

Has anyone ran into issues with this?

Has anyone been having issues with UCare claims for outpatient substance use disorder?  We have been struggling with this issue since Oct. 2016 and UCare doesn't have any answers for us for this main reason:  claims continue to reject and don't even reach UCare.  I've tried sending claims on both UB04 and CMS 1500 forms, I've changed the "Facility" under the client's Admissions tab from "13" to "89", and I've made sure to include both taxonomy codes (even though the first claims were sent before this was a requirement in March 2017)...I'm feeling at a loss of what to do now as we didn't have these issues prior to Oct. 2016.  We don't encounter UCare much, but now I have two more clients with UCare who are starting services.  Any advice?

P.S.  The following is the error/rejection message I get from Procentive in  the X12 Claim Data:  

Message Text:Category: Acknowledgement/Returned as unprocessable claim  The Claim/Encounter has been rejected and has not been entered into the adjudication system Status: Processed according to contract provisions (Contract refers to provision that exist between the Health Plan and a Provider of Health Care Services)