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BCBS & Prime West Residential claims NOT SENDING CORRECTLY - CHECK YOURS BEFORE SENDING

Jenna 5 months ago in Billing/Electronic Modules updated by sadie twite 5 months ago 4

Just wanted to give everyone a heads up to check your Blue plus  and Prime West claims prior to sending. Look on the actually HCFA forms once you scrub /check them  --- it is splitting room and board onto an entire different claim as treatment line. 


This is going to cause things to deny and dupes, deny as a whole because they are not in the format BCBS wants and they are picky on their requirement and potentially PW too. 


We have had a crisis ticket in for 2 weeks now with no fix from Procentive and over 200,000 we can't bill for. If yours are doing the same please submit a ticket as well. This is detrimental to businesses and needs to be fixed.

They seem to think its associate it with the value code option being added to the payer, but it doesn't matter if we use the value code or don't use it it will not send combined correctly.  They say they are not abruptly changing anything cause it could cause issues with other claims being sent without the value code. But again.... either way is NOT sending correctly. So something needs to be "tried"

They fixed UCare weeks ago for the same issues. 

I assume we are all having this issue but maybe just not all aware of it yet. 


Comment below if you are too? 


Jenna

+1

I'm sorry you're having trouble. 

Can I ask what procedure codes you're submitting with R&B, assuming that code is 1002 for R&B? 

I have not submitted the 1002 code for R&B with our residential services code H2036 for at least 2 years for Blue Plus, Ucare, PrimeWest and Hennepin Health with no issues. We do still have to add those for Health Partners and UBH/UHC/Medica. 

I bill the H2036 directly to the PMAP, alone, and the R&B directly to MA/MNITS. 

I'm hoping you get a resolution to your current issue. 

Thanks for posting this. I did notice this problem a few weeks ago and also submitted a high priority ticket.  

We have not had to include the room and board on PMAP claims to BCBS or PrimeWest since 2020, and send it directly to DHS.

We do however have the same issue with the Optum PMAP plans for Medica and UHC.  They do require the room and board on the claim with the treatment for us still.  Since they started to also require value code 24 we have not been able to bill.  Our ticket was created in Procentive on 6/22, and we've been told it's a top priority, but there has been no headway.

Hopefully this is fixed soon, we've got a considerable amount of billing on hold as well.

Alicia

Is it possible that you have your claim rules under the payer set up to put different codes on separate claims? I would review your claims rules to see if there is anything that might be triggering these to go out on separate claims.