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Withdrawal Management Claims - MA

2 months ago in User Group Help • updated 2 months ago • 2

I'm having an extremely difficult time getting a 245F withdrawal management claim to pay when billed out of Procentive to MA - both the treatment code with the room & board and only the room & board after it was billed to a PMAP. I've spent an extensive amount of time on this in the last two weeks with Procentive and the MHCP provider trainer. Here's what's happening:

Claims are being denied for units not matching date range (they do) and no DAANES entry (there is). When I last spoke with the provider trainer, she advised me that our claims are coming into their system as a hospital claim and searching for DRG rates. Procentive has confirmed that all of my settings are correct and that the claim going out the door all looks correct as well. They did make one suggestion - I've been including all the dx codes given for a client on the claim and they suggested trying only the primary diagnosis. I'll run a test claim that way as soon as I have one to run.

I'd love to know if anyone else has experienced this issue, and if not, how are you successfully getting your 245F claims to pay by MA?

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2 months ago

YES!! For all of our treatment lines on the claims - dates of service are not pulling through correctly but the room and board claims go through. The last I worked on it - Procentive reviewed and our set up is correct and the provider trainer reviewed and said it is not on their end but with how how claims are set up. This has been an issue for the last few years. I have not worked on it recently do to time but I am having my billers bill the straight MN DHS claims directly through MNITS. I plan to work this issue more when I have a new staff member fully trained. If you want to reach out through email please feel free. jzimpel@cadt.org