Does anyone know if it is possible to bypass a primary payer that does not except our codes when the client has a secondary payer that does except them? I.e. Modifier? 

NOTE - primary is NOT Medicare or a Medicare Product. (We use GY)

We are new to Procentive and I have a couple issues I could use help with. The first one is I am having trouble with rejections from Hennepin Health ,first on was about service codes fixed that resubmitted now the rejection is "service line days" looked at the X-12 summery and claims looked good! Anyone have any insight? Next pertains to BCBS Private claim we as a company do 96% consolidated and Pmaps, when I submitted BCBS paid one day on both claims called them and they said for Private I should not send HPCS  or modifers on a Private claim. does not seem correct to me. Would appreciate any help

We are new to procentive and I have two issues. First I am having trouble getting clients with Hennepin Health out of the module had an rejections on Unit codes fixed that now they rejected because of "service line days" looked on the X-12 summery and claims looked good. Any insight out there? Second issue is I cannot get a Private BCBS claim to pay at our private rate,called BCBS and they said that I cannot put HPCS codes and modifiers on a Private claim only on a Pmap,does not seem correct to me.95% of our clients are consolidated or Pmap so this does not come up often. I greatly appreciate any help.

We are trying to find the most efficient way to notify our clients of our 2019 rate changes in a timely manner.  We have some clients receiving electronic statements in the Client Portal and some receive paper statements.  

Is there a way to attach a file to the electronic statements that get sent to the Client Portal?  We need some kind of an efficient way of notifying these clients electronically and are open to all ideas.  

Thank you!  

KNOWN ISSUE:  Workflow Tasks are triggering retroactive workflows.  Our engineers are currently evaluating this issue.  We will update you when this has been resolved.  If you have any questions please send a ticket to Procentive Customer Support.

Thank you,

Rachael Smith

Onboarding and Implementation Team Manager

The Minnesota payers BCBS/Blue Plus, SCHA/MMSI, and UCare are making updates within the next 2 months.  We will provide you with more details mid-November, but here’s what you should do now: 

Blue Plus PMAP (of MN)

The Change: 

• BCBS is creating a new Payer ID number for Blue Plus PMAP to distinguish it from Blue Plus Commercial plans.
• As of December 1st, 2018, all PMAP claims will need to be submitted to a new Payer ID number.
• Procentive will automatically update the Payer ID in the new payer Blue Plus PMAP on December 1, 2018.

Action Required: 

• Add the new payer "Blue Plus PMAP" (ID: SB720) to the Payers Module. Copy over current codes and rates from the BCBS PMAP payer.
• Add the new payer to each client that has BCBS PMAP and begin using this new payer right away.  (Run Report 3070 in the Reports Module to see a list of all clients with BCBS PMAP.)
• Inactivate the old BCBS payer for each client as you add the new one. 

SCHA/MMSI

The Change: 

• SCHA/MMSI’s Payer ID will change as of December 1, 2018.

Action Required:

• Fill out the Electronic Funds Transfer (EFT) form you receive from SCHA/MMSI.  
• DO NOT fill out the Electronic Remittance Advice (ERA) form that they send you.  
• At this time no change within Procentive is needed. 

UCare

The Change: 

• UCare is creating a new Payer ID for UCare Family and Individual (currently called either UCare Choices or Fairview UCare Choices), effective as of January 1, 2019.
• Procentive will automatically update the Payer ID in the new payer UCare Family and Individual on January 1, 2019.

Action Required: 

• Add the new payer "UCare Family and Individual" (ID: 52629) to the Payers Module. Copy over current codes and rates. 
• Add the new payer to each client that currently has either UCare Choices or Fairview UCare Choices. (Run Report 3070 in the Reports Module to see a list of all clients with these payers.)
• You will need both the old and new payers for a client because the payer you submit to will depend on the Date of Service.  

Have further questions on what to do to prepare for these changes? Please submit a ticket to the Procentive Care Team.

Greetings to user group members interested in telehealth services.

There was a previous group discussion about telehealth that included concern about BCBS of MN's policy, which specifically excludes covering telehealth services provided when the recipient is in their home. This obviously is a problem because their PMAP product, Blue Plus, must be in compliance with DHS guidelines and DHS specifically states that telehealth services provided when the recipient is in their home is a covered benefit. 

So, I knew that BCBS's policy was a problem.  I tried to work with a BCBS representative, who basically hemmed and hawed, eventually acknowledged that their Blue Plus policies needed to comply with MCHP policies, but nothing changed. This took a couple of months. So,  contacted DHS last week, she requested a copy of my email discussion thread with BCBS, and a few hours after I sent this into  I had a call from a BCBS staff. . She asked a few questions and promised to get back to me "soon." The  next day I had another call from her. She was very apologetic, acknowledged that their policy was wrong, and she specifically stated that we can bill BCBS Blue Plus for telehealth services when the member receives them in the home. 

This leaves some questions about other BCBS "commercial" policies.  She said that most of their commercial products cover telehealth services but it will be necessary to check each contract to make sure that is not an exclusion for telehealth when the recipient is in their home. 

Richard Sethre, PsyD, LP

Procentive will be undergoing a scheduled maintenance window this weekend between 11 PM (CDT) Saturday, October 27 - 3 AM (CDT) Sunday, October 28.

The system may be unavailable intermittently during this maintenance period. We are only anticipating minutes of downtime but the scheduled window will last 4 hours. 

Thank you for your patience as we continue to improve our system.

I am wondering if there is any new info or ways agencies are able to start billing for professional staff being added to their agency. From what I have read we should not be having a fully licensed staff billing under another professionals license as they wait to be added as it may be fraudulent. I am wondering though how agencies deal with that?  We just waited about 6 weeks just to add a licensed staff to our agency with most insurance companies  who was already credentialed . How do agencies deal with this?