In the near future, we are hoping to add a Nurse Practioner to our facility, we are Residential Treatment for Adolescents Co-occuring.

  Our biggest hurdles are: 

1. how do we bill for her services,   Rev code, procedure code, etc.

2. Do we need to be credentialed by the insurance companies to add this service for billing?

3. We bill UB-04 can we bill for her services on a UB or do we need to use the 1400/1500

Help!  I can't find a definition of what the L,P,A, and F mean at the top of the Clinica/Charting Tap

Hello, 

We have a drug testing lab that does screenings. We have been billing drug testing codes 80307 and 80305 for our own treatment clients for a few years now, and we are just now gearing up to do drug testing for clients referred to us from outside of our own organization. My question has to do with entering a diagnosis code for a client who is coming to us from outside of our own organization. With our own treatment clients, they already have a diagnosis assigned by the clinical staff. With external clients, we won't know the diagnosis or they may not have one. Is there a catch-all diagnosis for drug testing that can be used? I found Z03.89. Does a clinical staff person have to assign the diagnosis? I'm doing the billing for service provided by our lab and there would be no clinical staff to individually assign a diagnosis to each client. We do, however, have a medical director who writes standing orders. I'm hoping someone with experience doing this can give some guidance on my diagnosis questions. Thanks.

Hello

I am wondering how other agencies deal with COB denials.  I have some claims pending due to requesting COB information from the policy holder for different payers. What is your process for these types of denials? Ive thought of sending the client a bill for the amount due. Any advice is welcomed1 Thanks

Just wanted to give everyone a heads up to check your Blue plus  and Prime West claims prior to sending. Look on the actually HCFA forms once you scrub /check them  --- it is splitting room and board onto an entire different claim as treatment line. 

This is going to cause things to deny and dupes, deny as a whole because they are not in the format BCBS wants and they are picky on their requirement and potentially PW too. 

We have had a crisis ticket in for 2 weeks now with no fix from Procentive and over 200,000 we can't bill for. If yours are doing the same please submit a ticket as well. This is detrimental to businesses and needs to be fixed.

They seem to think its associate it with the value code option being added to the payer, but it doesn't matter if we use the value code or don't use it it will not send combined correctly.  They say they are not abruptly changing anything cause it could cause issues with other claims being sent without the value code. But again.... either way is NOT sending correctly. So something needs to be "tried"

They fixed UCare weeks ago for the same issues. 

I assume we are all having this issue but maybe just not all aware of it yet. 

Comment below if you are too? 

Jenna

Does anyone have a work around for documentation/running progress notes for these billable services? I would like to have a note that is fluid and reflects updates/work in progress. At this time, each service line is an independent note, therefore, if searching for a task or step every note has to be opened. This is crucial when discussion coordination pieces that may need follow up and a running document can reflect what steps were made - VM left, who was spoke to etc.

Hello- Looking for input or to see if anyone else is having issues? 

UCARE has been processing 2022 Withdrawal Management claims incorrectly.  We received communication that the billing provider address is not contracted for Withdrawal Management.  Technically not wrong- the Line 2010 Billing provider is our main office.  Also on the claim though is line 2310- the service facility location that is contracted.  We are being told that the billing location has to be the service facility location.  The odd thing is that all claims for all payers go out with the same address set up and no issues with other payers, only UCARE.  Another point I do not understand is we offer several different services at several locations and those are processing correctly.

Has anyone been successful in getting paid from UHC-PMAP for residential treatment and SUD outpatient services? We are getting conflicting information on how they want us to bill residential treatment so I would love to hear what form and what codes you are billing especially if you are a 1115 waiver provider. Thank you in advance!

Ucare is telling us that they are not seeing a service location on our claims. They say they have been manually correcting this but will no longer be doing this going forward. The problem is that we can see the service location on our UB-04 forms when we send out a claim. Has anyone else heard of this and how did you correct it?