Hennepin Health (HH) ERA Adjustments?

Jeremy Roelofs-Lynch 4 years ago in Payments/ERA Modules updated 3 years ago 11

Hello, we have noticed that over the last few weeks our HH ERAs are coming with a bunch of adjustments; even though they paid the full amount. It is causing me to go in and manually change all the lines before saving it. 

I am curious if anyone else has seen this?

Hello Jeremy,

Did you get your issue with HH ERA's resolved? We are having the same issue and I was told by HH that the ERA file they show has no adjustments showing. 

I haven't been able to get an answer; they told me the same thing. We are submitting a ticket to Procentive to see if it's something on there end causing it. 

YASSSSSS and it is making me crazy!  Have you received a reply from Procentive yet Jeremy?  Sending in a ticket on this has been on my list of things to do but haven't gotten there yet.

We submitted a ticket weeks ago and Procentive pointed us back to Hennepin Health. It is not a Hennepin Health issue, as the files have not changed, but we went back to Hennepin Health again, and confirmed that. We reopened our ticket, but the more that are submitted, the more they'll consider having engineering look at the core issue.

Thanks for that info, Jason.  I'll open a ticket with Procentive then.

Heard back from Procentive:

Our engineers have already looked into this issue and there are a few items that play into it, however there is a setting that we have suggested users with this issue to change.

Please go to the Payers module > Claim Rules tab > "One date of service per claim" change to Yes > Save.

That helps with a separate issue, not the core issue here, though, which is the way the payments are posting on Procentive's side. As a side note, the payment amount we've seen (that tries to post) is 10% of what the total amount is for the line that goes out on the claim. Not sure that helps at all, have offered that to Procentive. I've reviewed the previous files and current files, no differences, so it's not a Hennepin Health issue, by any appearance to me.

I agree it's not a Hennepin Health issue.  The remits don't look any different, nothing has changed.  I don't necessarily know that changing the setting as they've suggested to Jeremy would even help. I'd have to look at my remits, but I think in instances where there's been one DOS but multiple charges, I still have this issue with payments being misposted.  So glad we have a low volume of HH clients, otherwise posting these payments would take forever with having to make manual corrections!

I agree that it isn't on HH side. We have a large volume of HH clients, it can take me 2-3 hours to post everything correctly.

Here's more of the response I got.

The biggest issue is that HH is not sending back the same coding information logic as they used to and while the payer states its the same, our team has verified that it's not. Contributing to this issue is the fact that there are so many DOS on one claim and because of how it's coming back (missing data) Procentive cannot allocate it out as it used to be able to do with the correct coding.

Eh, not sure I fully believe that.  Jeremy, have you ever posted payments by "allocating" them?  It is quicker than manually posting payments on service lines individually.

Im torn on if I will try splitting by dos. I have used allocating, I was having some trouble with some of these though!

Thank you.