Is anyone else having an issue with denied claims from Medica UBH when selecting LOA days on claims?

Good afternoon,

This afternoon I received a remit from UBH PMAP taking back payments as far back as February 2016. I called UBH to inquire the issue. They advised they "just found out" the client had primary insurance, BCBS. My response was, we are beyond timely filing to bill the primary insurance. UBH left us with no recourse or options to bill DOS from February 2016 to May 2016 due to timely filing. I then asked for the Appeals Dept.

My question to the community - What is your success going to the Appeals Dept with this kind of case? Can anyone provide insights to insurance payers having the ability of going this far back recouping payments because "they just found." Shouldn't payers have a timely response to these kinds of events vs recouping payments beyond one year after the fact? Thank you all for your time.

We are currently experiencing an issue with the Topaz signing window. Despite having the software installed and the signature pad connected, the Topaz signing window will remain grayed out. We are working on the issue and will update once resolved.

To sign clinical forms during this issue, you may continue to use a mouse or a device with a touchscreen.

Would anyone with experience using Client Kiosk let us know how they use it in a waiting room setting? We are looking to implement this soon, and if you would share your stumbles or successes I would appreciate it. We are planning to start with the waiting room model, and possibly add the client portal type forms later. Thanks to anyone who cares to contribute.

Has anyone had to bill UBH for interpretive services? We have our first client coming in with an interpreter and we need to bill their insurance.UBH was not helpful in what code(s) we should be billing.

REMINDER: PrimeWest Health Plan will be implementing their new change for institutional claims, requiring a valid Attending Physician's name and NPI to appear in the 2310A loop effective April 14, 2017. Please be sure that you've taken the steps outlined below from our mass email sent out March 31, 2017 prior to April 14th to prevent claim rejections and denials.

If you have any questions regarding this change, please submit a ticket to the Procentive Support Desk.

Thank you!

Does your clinic charge late fees or interest to clients whose balance goes unpaid after a certain # of days? Do you feel this really helps to get payments sooner? Is it more of a hassle administratively? How do these fees or interest show up in a Procentive statement? Please give me any input on this as our clinic is revisiting this part of our policy. Thanks!

We've received the below information from MN MA/DHS:

"MN Medicaid’s Real Time Eligibility applications are currently experiencing sporadic outages due to issues with the MMIS Mainframe. You may experience sporadic timeout responses, and/or AAA errors with AAA03 = “42” (Unable to respond at current time). Our Mainframe staff are working to resolve the issue. We will send an update when the issues are resolved."

Please note that this may result in "No Response" status' on claims in the Electronic Module and errors when running eligibility until MN MA has this resolved. We'll update this post as soon as we know more. Thank you!

With clinical trainees, is the clinical supervisor (the one who fills the role of CS as defined by MN Statute) often times different than the billing supervisor? If so, what criteria do you use to choose a billing supervisor NPI to travel with the claim.

In the Procentive staff module, there are 2 fields: one for billing super and one for clinical super. In the payer module, there is also a field for billing supervisor which is the NPI that gets billed with a clinical trainee's service lines.

I'd like to hear how agencies are using the Procentive features, and how they decide which NPI to send with the claim.

Thanks!

Kim