Has anyone been having issues with UCare claims for outpatient substance use disorder?  We have been struggling with this issue since Oct. 2016 and UCare doesn't have any answers for us for this main reason:  claims continue to reject and don't even reach UCare.  I've tried sending claims on both UB04 and CMS 1500 forms, I've changed the "Facility" under the client's Admissions tab from "13" to "89", and I've made sure to include both taxonomy codes (even though the first claims were sent before this was a requirement in March 2017)...I'm feeling at a loss of what to do now as we didn't have these issues prior to Oct. 2016.  We don't encounter UCare much, but now I have two more clients with UCare who are starting services.  Any advice?

P.S.  The following is the error/rejection message I get from Procentive in  the X12 Claim Data:  

Message Text:Category: Acknowledgement/Returned as unprocessable claim  The Claim/Encounter has been rejected and has not been entered into the adjudication system Status: Processed according to contract provisions (Contract refers to provision that exist between the Health Plan and a Provider of Health Care Services)

Good Morning!

We have received notice from DHS that there is a "time out" error occurring with eligibility as of 9:45 AM CDT. This is currently being worked on by the DHS Operations Team but there is no ETA at this time.

Please check back here for updates - we will post again when DHS has this resolved.

Thank you!

NGS Medicare has sent an email to all subscribed providers. For your convenience, this notice is below:

What Happened: 
National Government Services (NGS) is informing Part B providers of an issue involving claims that did not successfully crossover to the supplemental carrier. Provider remittance advice (RA) indicated in error that claims had automatically crossed over to the supplemental insurance carrier. Letters were later issued advising that claims could not be sent to the supplemental carrier due to the reported ICD-10 diagnosis code being truncated.
 
The codes are not truncated at this current date of service.
 
Why It Happened:
The issue occurred because the Benefits Coordination & Recovery Center (BCRC) edit validator may have installed “higher level of specificity” ICD-10 diagnosis codes a few weeks before 10/1/2017. The BCRC consolidates the activities that support the collection, management and reporting of other insurance coverage for Medicare beneficiaries. The purpose of the coordination of benefits (COB) program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare payments. The BCRC coordinates with the Medicare Administrative Contractors (MACs) in crossing claims over to the supplemental insurers.
 
What This Means to You:
If you received one of these letters advising you the claim was not crossed over to the supplemental insurer, you will need to submit the claim directly to the secondary insurer. With the 2018 ICD-10 upgrade, the new diagnosis codes will go into effect on date of service 10/1/2017. Please be aware the changes to ICD-10 that may affect your practice.

If you would like to receive emails from NGS Medicare, please visit their website. After logging in or continuing as a guest, please click the "Subscribe to Email Updates" link on the top right (under the search box).

For consolidated providers MN MA (DHS) has ongoing problems with eligibility, which is causing some consolidated providers to be unable to check eligibility (except through IVR). The details from DHS are as follows:

Some MN–ITS transactions involving consolidated providers are experiencing issues, including: Eligibility Request (270), Authorization Request (278) and Service Agreement Request (278).
Consolidated providers who need to check eligibility or check the status of an authorization request or service agreement may call the Provider Call Center at 651-431-2700 or 800-366-5411. 

We have confirmed with DHS that this does apply to batch eligibility which how eligibility is checked through Procentive. If you wish to monitor the progress of this, you can find it on the MHCP Provider News and Updates page.

Once we know this has been fully resolved we will update this post.

Have a fantastic weekend!

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As of 8/1/17 Humana has discontinued their Behavioral Health ID 61104. All claims for Humana should now be sent to the existing Humana ID 61101.

If you are submitting claims to Humana Behavioral Health using the payer ID 61104, you may see this rejection:

Error Code: RECEIVER_FAIL
Error Message: The payer ID is not valid. Please correct and resubmit the failed transactions.

If you receive the above rejection and have not already resubmitted under the Humana payer ID 61101, please submit a ticket to the Procentive Support Desk and we will update your Payers Module to use ID 61101.

Thank you!

I have a few questions I am hoping can be answered in this group. Is there a way to copy a form template in Procentive and rename it to have all staff utilize? I know that I can copy a note that is already in a client's file, but I would want this to be a form that staff can choose. We are wanting to have a form for Tx Plan Development. Is Procentive the only one that can change forms etc...

Second we have multiple programs and would like the Tx Plan to flow to each program with one Tx plan instead of having let's say one tx plan for CTSS and another for MH. Is this a simple as adding the program to the Tx Plan form? 

Thank you for any information

Teresa

My organization is considering Integrated Credit Card Processing.  For those of you currently using this feature, would you recommend it?  What are the pros and cons you would suggest considering before moving forward?

Can one provider bill a Individual Treatment Plan and another provider bill Functional Assessment on the same day?