Insurance Verification

Following

I just went on navinet to look up an Aetna ERA and they showed a program called "All Payer Access. http://info.navinet.net/all-payer-access?utm_campaign=APP%20Launch&utm_medium=Portal&utm_source=Home%20Page%20Ad

I sent in my info for a cost check on it.

Hi Mandy! I have been looking into the possibility of partnering with Availity to improve Procentive's eligibility module. I am curious -- when you say that Availity doesn't work so well for some insurance companies -- what do you mean? Do you have any more information you could provide? Thanks!

Thanks Kevin - this is the reply from my staff:

"When you pull up the benefits/coverage information to look up the benefits and click on Mental Health there is no information. So you have to pull the information off the general Health care service but that doesn’t show the copay or co-insurance so you end up having to call BCBS."

Wait times for BCBS at the moment are over 60 minutes!

If you select the print option to print the benefit info, select to include the mental health category, a .pdf file will be created and the individual benefit info for mental health appears. I then keep a copy of the .pdf file in a benefit and eligibility file to upload to Procentive.

This is a GREAT idea! I know using Availity can be frustrating. Be sure to indicate in the drop down area that you want Outpatient Mental Health - provider. I've also noticed the new feature of being able to print a client's insurance card.

What I've been told by my staff is that they cannot find ANY online insurance verification site which accurately provides billable codes, remaining units (if limited), etc. So we routinely call each Insurance company to verify that a particular person & license (LMFT, LPCC, etc.) will actually be able to bill a particular set of Mental Health codes for a client. This takes forever (BCBS 60-minute wait time isn't unusual), and is, of course, quite expensive as it's a manual process. Not quite as expensive as billing and getting denied however. If anyone has online sites that actually provide this information for Mental Health codes I'd be ever so grateful.

This actually matches the research I have been doing on this. In the attached doc from Blue, it shows that for MH services -- "only Active/Inactive will be returned. Responder is prohibited from returning additional or full liability information."

prov_hipaa_matrix.pdf

What this document suggests to me, is that even if you use a different tool to check eligibility for Blue (outside of Availity), you would likely get the same generic response. BUT if anyone else out there in Procentive-land has had a different experience, I would love to hear about it.

We are currently calling BCBS and waiting on hold forever!!!

I do not know of any online site that shows us what MH code we can or can't bill, if we want to know a particular code, ie family codes 90846/90847 bc it seems like more and more plans do not cover those, we have to call. We can usually find CCD on payer sites or Availity though.

I do not know of any online site that provides that information either. On Availity, if you select "Additional Benefit Notes" in blue, and select mental health, it will list any exclusions. It doesn't work for all patients but almost always does for Minnesota plans. You are able to print these also. For example (taken from Availity):

• No specialty network for mental health and substance abuse
• Marriage/couples counseling is NOT covered