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Health Partners Treatment and Room and Board

susan 2 months ago in Billing/Electronic Modules updated by AmyB 1 month ago 10

We are being told by Health Partners PMAP that they still want to see the room and board line along with our treatment line, including the value codes.  Currently claims are not clearing electronic for these as the claims have more than one value code on them.  Is anyone else having an issue with this and how are you getting around it.  This is in MN...

We are having several issues too with HP claims and BCBS Claims.  Working with Procentive on correcting their set up but have not had any resolution. 

+1

We are having issues with Hennepin Health, HPC, and Blue Plus and the Value code issues. I sent a  email to the BCBS rep and they said:

I have spoken to a lot of other SUD reform providers as well who are submitting with no problem. The only ones that seem to have problems are the ones that use Procentive as their clearing house vendor or therapy brands which they appear to be having internal software issues.


I have tickets with Procentive but they do not have fix so my claims are not clearing out. They want us to get all kinds of information from the insurance companies to get LOOPS, SEGMENTS, ETC.. to provide to them. I wish they would just reach out to the insurance companies since it is their software and get this straight versus us putting in all the leg work.

** Beyond Frustrated**

We do not add the value code to the Room& Board code that is submitted to Health Partners so our claim only contains the treatment line value code and has a zero dollar charge. We only add this Room & Board code to Health Partners PMAP, UHC PMAP products and commercial payers, not Blue Plus if that helps with your 2nd comment. 

Thank you, I am looking into this more but I have tried to send claims as you have above and they are still rejecting for us.  I might be missing something though. 

Hi, So  you bill out the treatment code (H2036) or (0944/0945) with a Value code and then the second line 1002 with a zero charge and no Value code? To get the 1002 room and board paid via MNITS it needs a Value code so do you bill out the 1002 (VA) also on the residential calendar? 

Do you enter 3 lines on the residential calender?

Treatment code--send to pmap

room and board with zero charge--send to pmap

room and board with Value code--send to MA directly



+1

Yes Amy, you are correct. We have 2 different room & board codes set up. One with a charge and value 24 code to send directly to MNITS and the other with zero charge or a penny to go to those payers that require it, with no value 24 code. We have the auth lines set up with no auth number on the MNITS auth line and the appropriate authorization number added to both the R&B code and treatment code in the other payer that requires both codes so they are on the same claim. 

okay good i am now set up that way so keeping fingers crossed it works.

How are you getting these claims to go through and not reject?  I have two different codes set up for the room and board, one with the value code and another without.  I have tried to send multiple claims to both HP and BCBS but no matter what room and board code I use they reject due to a value code error.  The engineering team is working on it I was told but there is no ETA of when it will be resolved and we have been on hold with billing for over a month of services. 

Hi, my claims are also denying LaVonne so I am curious what we are doing wrong. I have mine set up like i wrote above but it isn't working. I am also having issues with Hennepin Health and Healthpartners regarding value codes.

Larry at BCBS said it is an internal Procentive software issue/Therapy brands. All other providers that don't utilize Procentive as their billing software are getting claims through and paid correctly JUST issues with billing that is done through Procentive.

 This is what they said to my ticket:

Posted on: 12/20/2022 04:52 PM
Holly Byrnes says:
Hi Amy,

So this issue is actually already being worked on by our product/dev team to update some payer coding so that only the Treatment Code Value 24 Code will travel, which should clear the rejections you are getting from what we have heard from other agencies. They are close to getting this done, so once it is done I will let you know and have you do a test resend to see if it clears and go from there!

Thanks,

Holly

Yes we are very frustrated too.  I have sent emails to our insurance contacts and sent Procentive all the information along with our insurance contact information.  It seems though the more rejection examples and the more information I send Procentive the more they ask for.  Nothing has changed except these value codes so I do not understand why the documentation is needed from the insurances.