Need help troubleshooting a clearinghouse rejection. Randomly, there is a 3 week period in which a large portion of my OP SUD Ucare PMAP claims are getting rejected citing   ":ENTITY'S SPECIALTY CODE, ENTITY'S SPECIALTY, TAXONOMY C
ODE.:ATTENDING PHYSICIAN"

I cannot figure out where this is stemming from. Nothing has changed w/our clinicians, billing, coding etc and the taxonomy code is the same as it has been. Strangely, this was only an issue for a few weeks in April.  Did anyone else have this issue?  Solutions?

Does anyone bill SUD to UHC? Are you getting payment? We were told that UHC doesn't allow the H2035 code. Our claims are all denying for needing a PA or rendering provider is not eligible to perform the service. When calling UHC to verify coverage, we are told no PA needed.

We provide Chemical Dependency & Mental Health for levels of care of PHP, & IOP.  We have been having issues with BCBS ND Medicaid Expansion paying on our claims, only to come back now and take the money back from us.  When I called to ask why they took the money back from us, they keep telling me its because of an invalid Type of Bill and Status.   They keep telling me that its coming through as 1-Admit to Discharge, so to look at AMA Correct Coding Guidelines and resubmit once we figured out how it should be billed.   That's where I am lost. 

We bill using UB04 claims for most of these services.  In the admissions tab we use with a 13-Hospital Outpatient and put in the client's Admit Date & Time and put the Status as 30-Still Patient.  We file this these options with all of our claims.  Once the client discharges, then we will go in and put the Date & Time and then change the Status to the appropriate Discharge status.  

Any ideas as to what they are meaning with 1-Admit to Discharge and what it is we may need to change in Procentive to get our claims to go through properly.  We have billing the above way for over 10 years now and have never had this type of issue before and so far it is only with BCBS ND Medicaid Expansion claims and so far only on just random dates of service have they taken their money back from us on. 

Any help is greatly appreciated!

Does anyone know if you are able to export a billed invoice to Excel in order to edit?

Thanks!

Hello, are there any organizations that are currently billing the codes S0280 and S0281 for behavorial health homes. We are wondering how these get billed out of Procentive? Do you just create an individual session once a month to bill this or do you bill off of a residential calendar? Any other pointers you can give us?

Has anyone else experienced problems when billing the 99354 add-on code for an extended session for 2023 DOS? Claims are rejecting in the Electronic Module. This was a BCBS commercial policy.

Stating the following:

Error Message: Category: Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Status: Line information

Error Message: Category: Acknowledgement / Rejected for relational field in error. Status: Procedure code for services rendered

Error Message: Category: Acknowledgement / Rejected for relational field in error. Status: Date(s) of service

Error Message: Service Line Data: SVC*HC:99354*120*****1~Version: 5010A1 Loop: NA

Thanks, Sara

Does anyone who provides ARMHS have an issue this year with the ARMHS Provider Notification/Change Requests? We have turned these in every January for clients continuing with ARMHS from one year to the next. This year, they are asking for the DA, necessity of care, FA and ITP. We have only ever had to turn this additional information in for an authorization and this is just supposed to be a notification of care for UCare. They implemented it so clients could not be seen for services by more than one entity. Just looking to see if anyone else has come up against this. Thank you!

Is anyone finding the Processing of billings are sitting and waiting as sent.   It doesn't matter if they are Availity or MN DHS.

DHS is telling me that the diagnosis F43.89 is not compatible with a 90785 and/or travel code H0046. Has anyone has this issue yet, since the diagnosis changed in October?

Thanks for any help!

Did something change for facilities that bill Comprehensive Assessments? Previously I billed all claims as Institutional and yesterday I received a denial from MA for a comp claim stating I used the wrong form. Can someone help me?