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)

Can one provider bill a Individual Treatment Plan and another provider bill Functional Assessment on the same day?

I have been told that we need to copy a clients DL along with Insurance card when they come in as new clients. I have a client who has refused and doesn't want her DL copied. Is there something that I can show her in writing that we are required to get this. She called BCBS and was told she does not need to provide this to us. I need to get back to her on this, any thoughts or suggestions?

All of our  BCBS electronic billing files rejected with the error "Submitter not approved for electronic claim submissions on behalf of this entity
 Entity: Submitter"  Anyone else experiencing this?

Has anyone else billed Tricare for Residential Treatment?  No matter what revenue code I use, Tricare is rejecting my electronic claims and I cannot get them to go through.

Hi all, Not sure I'm posting this in the correct forum. I'm looking for some information about coding for interactive complexity for clinicians doing play therapy. When adding this to 90837 or similar service line, do other clinicians typically record notes for both service lines or is a note for only one (or the other sufficient)? Our interactive complexity codes got denied and they were added at the same time as the main service code but notes were only included with the 90837 line so wondering if that was the problem. Any help with this would be welcome.

I'm fairly new to Procentive, so this subject may have been covered...

I got a calim back from UCare. It has takebacks which are fine...after processing almost everything in the claim, I'm still 2.77 short for a payment on a claim. That amount is in the left hand corner of the ERA in a blue dotted box  that says:

Date              Code        Adjustment

12/31/2017    L6:IX        2.77

Is that available to use? If so, how do I process it? I found information on the Procentive Knowledge Hub about interest payments, but that doesn't seem correct.

TIA!

How many of you find it difficult to work with the BCBS Affiliates and their Blue Card Program.  It seems our experience goes one of 2 ways...either the UM/claims go through without an issue or we have nothing but an issue out of the gate (often it revolves around coding...specifically the H205 (HQ).  The struggle is they want us to bill a per deim code when statutorily the H2035 is all that is available.  It is when we have an issue that rarely is it fully resolved.  Currently we have 3 active claim issues one dating back to 2015.  BCBS-MN seems to give it a half hearted attempt to resolve.

Recently for Blue Plus when billing out individual lines of 96101 they will pay on one line and deny the others saying it is duplicate.  I was told that I now have to use a modifier to bill these out? What modifier should I use? I am only having this issue recently with Blue Plus.