Hi Community,

I'm hoping someone out in the community has an answer to this question.

If an ARMHS client has Medicare as their primary insurance payer and PMAP/MA as their secondary payer and is seeing a NON-Medicare provider, how to we bypass Medicare and bill the PMAP plan or the MA plan as the primary insurance plan? Do we need a modifier to do so?If a modifier is required, what is the modifier code used bypassing Medicare, billing PMAP/MA as the primary payer.

I'm advised we should bill Medicare first and get the denial then send the claim to the secondary plan, PMAP/MA.

Does anyone have experience with this? I'd love to hear from someone. Thank you for your time.

We have a therapist who wants to provide Exposure Therapy but we've never billed this before. Are there any pitfalls, tricks or do you find insurances won't pay for it?

Also, she wants 1-1/2 hour sessions - since there's not a code for this unless it's a crisis what code(s) work?

Thanks - any assistance would be appreciated! Kay

I would love some feedback from anyone who has had a satisfactory experience with work flow and workflow definitions. How did you set it up and how is it working for your agency?

Our company is having some difficulty submitting claim code H0031 (Functional Assessment) to Blue Cross Blue Shield as they are not recognizing our unit formula: 1unit=15min, and is rejecting our claims. Does anyone have experience with submitting H0031 to BCBS, and if so, what do you claim for the units? I submitted a ticket on this and our Procentive support agent suggested we bill it as only 1 unit but check with the community.

Thanks for the assistance!

We're newly CTSS certified and trying to determine how to use the UA modifier on under 18 clients who have MA/MAPMAP's. For those of you already CTSS certified, if you have the UA modifier set to attach automatically when you select CTSS in the client/payer/enrollment module, does it attach for ALL services and get reimbursed? When did you begin using the UA modifier?

Is anyone Billing Crisis Services for Mobile Crisis Outreach (MCO) Services to Commercial Insurance? If so, what codes are you using to bill and which insurance companies are paying?

Thanks!

Does anyone know of a voice transcription product that would be compatible with clinical charting in Procentive?

For those of you who are billing Telemedicine...what POS do you use when sending in claims?

would love to hear what agencies/private practices are doing with regards to posting the z-codes in client module/diagnosis tab. Since they can't be billed do they need to be posted there rather then just on the clinical documents?