This article is no longer accurate. Please review this topic instead.

As of January 1, 2018 Tricare will be making the following changes:

• Claims contractor will no longer be PGBA
• New claims contractor will be Health Net Federal Services (HNFS)
• North Region and South Region are being removed
• East Region will replace the previous North and South Regions

What does this mean for you?

If you are a Tricare provider and would like to continue receiving EFT and ERA, you will need to fill out and submit the following applications:

• For ERA: Tricare 2018 ERA Pre-Enrollment Application
• For EFT:  Tricare 2018 EFT Pre-Enrollment Application

You may have received these applications in the mail however, we want to make this process as easy as possible for you so we have re-created these paper forms as fillable PDF documents! 

Please submit these completed applications to:

HNFS at 1-888-282-2841 Attn: T2017 West EFT/ERA

AND

Procentive at 1-888-354-9053 (ERA application only)

If we do not receive a copy, we will be unable to assist you in the application process.

Thank you!

I have multiple claims that are being denied because Medicare isn't putting "Contractual Obligation" in the COB when we forward our claims to a PMAP. So, it makes it look like there is no beneficiary obligation to the PMAP. Anyone know if this can be fixed? Or what the easiest process would be?  It's impossible to talk to someone at Medicare, so I figured I would check here

I am wondering if anyone else is having issues with the primary EOB information being sent along with claims? I have noticed with our Wilson McShane (BCBS) claims and some of our UCare PMAP claims, we send it to secondary with the primary payment information added into the "COB" tab in Procentive and they still come back denied. For many of the claims I have to fax in paper copies of the EOB's otherwise the secondary insurance cannot see it any they deny. Any suggestions?

We have received notice from the clearinghouse that claims sent to Cigna after August 19, 2017  with any of the following diagnoses were rejected in error:

The affected claims were rejected with the following rejection messages:

A3:254 - Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Principal Diagnosis Code for Service(s) Rendered.
A3:255 - Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Diagnosis Code for Service(s) Rendered.

If this applies to you:

Cigna is working to resolve the issue.
•  Claims that rejected on or after 08/20/2017 will be identified and corrected.

•  No action is needed. Estimated Completion Date: TBD
•  An updated batch report will be sent upon the correction of the rejected claims.

Thank you!

Are any other practices having issues with Procentive being down today? I can't get into the ticketing module to send a ticket and the boss is getting anxious. There were a couple frozen pages initially and then it worked for a while. Now it is down completely.

Can anyone share what system/program you are using for telehealth appointments?  Pros, cons?  Thank you in advance!

Sheryl

We are currently getting error messages when trying to navigate the client module, and when saving or opening appointments, etc.  Anyone else seeing this?  Many staff are reporting it here.

For any of you who are MN CTSS providers -

1. Has anyone had an unannounced site visit?

2. If you have more than one CTSS location, is each site individually certified for CTSS svcs?

3. For your Disclosure of Ownership form, who do you have listed as having "ownership" in your organization?  (Board of Directors, President/CEO, supervisors, etc.)

4. Is everyone aware there is a state-approved interpreter list and only those interpreters are reimbursable by state funds?

Thanks in advance for your input!

Is it possible to add multiple clients to one staff other than doing it individually for each client? We have about 40+ clients and around 35 staff and every time we hire a new employee, I have to add them to each client 1 by 1. Is it possible to add 40 something clients to 1 new staff all at once vs. adding 1 new staff to 40 different clients individually?

When new reports are created (DA's, EIDBI ITP's, and CMDE's), can the diagnosis date/ITP date's/CMDE dates automatically post in the client's module under the diagnosis/treatment plan tabs? If so, how can we make this happen?