At this time I'm just wondering if anyone is having these denials. We may be asking for help!

Our scenario: Starting in August, after BCBS MN had an update to provider types, we got denials for clients who see our LMFTs and have a BCBS IL plan through their employer. We have started an appeal process over these denials. Now BCBS IL has recouped payments made from Jan to July; we've included a request for re-payment in our appeal.

Thanks, Kay

We are looking at billing for group psychotherapy for the first time, specifically Therapeutic Yoga. Any advice or guidance? Looks like code 90853? What about reimbursements, time? Thanks!

When billing clients that have MA or PMAPs, is there a way in procentive to skip billing Primary once they deny CTSS services?

Looking for some advice on how to track client contact in order to bill target case management tiered billing system. Does anyone currently use this billing system for their TCM program? This system allows you to bill at a higher rate as long as you have a certain amount of client contact. If you have billing system you are willing to share let me know. For audit purpose we will need to be able to document the client contact(clinical note and or time add??)

The ICD10Data.com site says this about the bereavement Z-code;

• Z63.4 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes
• That makes me think I CAN bill it. The client's Mental Health benefit detail link(BCBS,Availity) says that marriage counseling(another Z-code) is NOT covered but doesn't mention bereavement counseling.
• Is there some unwritten rule about Z-codes that I don't know about?

ome providers are having issues with billing Medica for mental health and chemical dependency claims since January of 2016 (change went into effect). Can anyone advise me on how they are billing these claims? Medica is requesting all residential billing be billed on a monthly basis and if a client misses one day (hospital, etc.) then the provider will need to bill that day(s) as a Leave of Absence (LOA). Has anyone billed this way? If so, could you provide some guidance regarding what revenue code you are using and what fields of the UB-04 form you are filling out to complete this claim? I appreciate your help. Thank you.

I'm sure some providers are having issues with billing Medica for mental health and chemical dependency claims since January of 2016 (change went into effect). Can anyone advise me on how they are billing these claims? Medica is requesting all residential billing be billed on a monthly basis and if a client misses one day (hospital, etc.) then the provider will need to bill that day(s) as a Leave of Absence (LOA). Has anyone billed this way? If so, could you provide some guidance regarding what revenue code you are using and what fields of the UB-04 form you are filling out to complete this claim? I appreciate your help. Thank you.

Hi Community,

I'm hoping someone out in the community has an answer to this question.

If an ARMHS client has Medicare as their primary insurance payer and PMAP/MA as their secondary payer and is seeing a NON-Medicare provider, how to we bypass Medicare and bill the PMAP plan or the MA plan as the primary insurance plan? Do we need a modifier to do so?If a modifier is required, what is the modifier code used bypassing Medicare, billing PMAP/MA as the primary payer.

I'm advised we should bill Medicare first and get the denial then send the claim to the secondary plan, PMAP/MA.

Does anyone have experience with this? I'd love to hear from someone. Thank you for your time.

We have a therapist who wants to provide Exposure Therapy but we've never billed this before. Are there any pitfalls, tricks or do you find insurances won't pay for it?

Also, she wants 1-1/2 hour sessions - since there's not a code for this unless it's a crisis what code(s) work?

Thanks - any assistance would be appreciated! Kay