UB04 Claims - Admission Tab

ahuseby 1 year ago in Billing/Electronic Modules 0

We provide Chemical Dependency & Mental Health for levels of care of PHP, & IOP.  We have been having issues with BCBS ND Medicaid Expansion paying on our claims, only to come back now and take the money back from us.  When I called to ask why they took the money back from us, they keep telling me its because of an invalid Type of Bill and Status.   They keep telling me that its coming through as 1-Admit to Discharge, so to look at AMA Correct Coding Guidelines and resubmit once we figured out how it should be billed.   That's where I am lost. 

We bill using UB04 claims for most of these services.  In the admissions tab we use with a 13-Hospital Outpatient and put in the client's Admit Date & Time and put the Status as 30-Still Patient.  We file this these options with all of our claims.  Once the client discharges, then we will go in and put the Date & Time and then change the Status to the appropriate Discharge status.  

Any ideas as to what they are meaning with 1-Admit to Discharge and what it is we may need to change in Procentive to get our claims to go through properly.  We have billing the above way for over 10 years now and have never had this type of issue before and so far it is only with BCBS ND Medicaid Expansion claims and so far only on just random dates of service have they taken their money back from us on. 

Any help is greatly appreciated!