SCHA Outpatient Bill Type

BillingAS 3 months ago in Billing/Electronic Modules updated by Katie Scharberg 2 months ago 10

SCHA just started processing claims this week and denying claims that end with a bill type of 1 if the the patient status is not discharged. Procentive has all of our outpatient claims processed as 0891. It sounds like we can change it in Procentive that the bill type always ends in 1, 2, 3, or 4. I am thinking of having them all process as ending in 3 so the majority of claims get paid. But am still contemplating the best way around this situation that is the least labor intensive so am looking for ideas on what others are doing.

SCHA states they are still looking into this and they were not aware of the change either but have been getting calls from other providers about this. They believe is may be a CMS edit that they are following. Has anyone else gotten any other feedback from SCHA or Procentive about this? Is any one seeing other payers implement this new change that I should be aware of? 

We don't have many SCHA IOP clients but I JUST starting getting this denial for Blue Plus IOP claims and was wondering the same thing. I have changed just that payer set up to have the TOB to be a 3 to start with. 


I received denials from SCHA for missing/incomplete/invalid discharge information today on all IOP clients except for the assessment (H0001) that I billed as a professional code versus institutional. Previously we've had no issues with billing for assessments as institutional codes. I am wondering if all codes need to be switched to professional codes now?  

I am waiting for reps at SCHA to get back from lunch at 1 pm. 

I just spoke with SCHA - the rep i spoke to was saying that the "30 service code" is the issue versus the bill type of 1... I don't know but I am sure tired of all these billing issues this year! 

I was told since the patient status is 30 and the bill type 1 the patient status should be a discharged status as that is what would match the bill type of 1 (admit-discharge). Will they accept groups and individuals on professional claims? 

Also yes I hope this is the last of the issues for this year at least. 

She did not think switching to professional would work... She said they are sending claims back for review and hope to return my call within the week... Maybe Procentive can advise a temporary solution? I can't imagine going another week or two without our expected revenue. 

Anyone receive any updates or payments from SCHA? We are still getting denied. 

No updates they said they would call me but nothing

I received a call back from SCHA - they confirmed the claims need to be billed with a type 2, 3 or 4 effective 3/1/24. Any feedback on how to switch the claims and not mess everything else up for other payers? 

Same here, I switched them in the payer module under SCHA and Blue Plus so claims go out with a bill type of 3. Its under payer rules, outpatient bill type.

Awesome- thanks for the assistance!! fingers crossed the billing issues are over for the year!