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Primary EOB's

TessaLasky 3 years ago in Payments/ERA Modules updated by Ashley Kallod 3 years ago 4

I am wondering if anyone else is having issues with the primary EOB information being sent along with claims? I have noticed with our Wilson McShane (BCBS) claims and some of our UCare PMAP claims, we send it to secondary with the primary payment information added into the "COB" tab in Procentive and they still come back denied. For many of the claims I have to fax in paper copies of the EOB's otherwise the secondary insurance cannot see it any they deny. Any suggestions?

I had this a lot when I'd have Medicare as a primary and a MN DHS program as second. I'd have to go in and add in information on the DHS website. Took forever. I work in Mental health and Medicare denies ARMHS codes, so anything that would be considered "ARMHS" would not get sent to MN-ITs. We ended up needing to make a second Medicare profile to ensure information gets attached to the secondary claims. This seems to help.  Not sure why BCBS would be doing that. Is their a common primary provider? 


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Regarding ARMHS - skip Medicare in billing. Medicare does not cover, and MA/PMAP's will cover if billed directly. UCare SNBC doesn't generally cover ARMHS, as far as we have found. They generally won't cover anything not covered by Medicare. We call ahead on all ARMHS clients, when they have UCare SNBC plans, prior to seeing the client.

Does this also apply to Substance Use Disorder services?

Sorry, I am not sure why I never responded to this. We provide CTSS services and Inpatient services for children. I am still coming across this issue but it seems to be more common across most of our insurance companies. I know that through the ERA module, the EOB information will automatically be saved in the COB tab for each claim. Even when I manually add the EOB information it is not being sent out on the claims, according to the insurance companies. At first, I thought it was an issue on their side but it keeps happening more and more. I may just end up ticketing the help desk at Procentive, I just wanted to try it out here to see if others were having the same issues.