0

UCare Claims issues

drake.akallod 2 years ago in Billing/Electronic Modules updated by Chris 2 years ago 4

Has anyone been having issues with UCare claims for outpatient substance use disorder?  We have been struggling with this issue since Oct. 2016 and UCare doesn't have any answers for us for this main reason:  claims continue to reject and don't even reach UCare.  I've tried sending claims on both UB04 and CMS 1500 forms, I've changed the "Facility" under the client's Admissions tab from "13" to "89", and I've made sure to include both taxonomy codes (even though the first claims were sent before this was a requirement in March 2017)...I'm feeling at a loss of what to do now as we didn't have these issues prior to Oct. 2016.  We don't encounter UCare much, but now I have two more clients with UCare who are starting services.  Any advice?


P.S.  The following is the error/rejection message I get from Procentive in  the X12 Claim Data:  

Message Text:Category: Acknowledgement/Returned as unprocessable claim  The Claim/Encounter has been rejected and has not been entered into the adjudication system Status: Processed according to contract provisions (Contract refers to provision that exist between the Health Plan and a Provider of Health Care Services)

Yes, I've had an issue with Ucare regarding the rendering provider's taxonomy 'not showing up" on Ucare's side.  It was only for one patient for services both before and after the requirement.  After the requirement, I've had not had any issues with other clients.  The CMS 1500 in the Procentive shows BOTH the facility taxonomy and rendering provider's NPI numbers in the correct boxes (24J and 33B).


This was a ticket from July 24 with Ashley Morschen from Procentive : "I verified that the staff's taxonomy is being sent on the claim per the new requirement from UCare and that the taxonomy is what is registered to this staff's NPI. This leads to the belief that there is an issue within the UCare system that is causing the taxonomy not to be present when the representatives you speak with are looking at the claim.   To resolve this, you will need to push back on UCare a bit. Speak with a representative at UCare and have them tell you where the information is missing from the claim in regards to the LOOP and SEGMENT. This is the electronic standard claims are sent/received with and how they appear before the payer's system translates them onto a HCFA for easier reading.  Without knowing the LOOP and SEGMENT where information is missing or incorrect, we are unable to determine what needs to be changed in Procentive - or if the reason they're providing you is even correct. "


I called Ucare several times to explain there may be an issue and mentioned the above information that Ashley provided me with.  They called be back a month later and told me I needed to go through the claims appeal process.    

It's been 4 months and through all of this I've not had any luck or resolution. 


I too am getting this for 1 client. I will try to get thru


I was told that the submitted NPI (supervised clinician) was not credentialed for Choices plan, but was for everything else. They were going to get her credentialed for the plan and Cameron said we had 365 days from DOS to resubmit.

Drake (or anyone else),


Did this ever get resolved. We recently had our first UCare client for CD services and we cannot get a claim to go through Procentive.


Message Text:          Category: Acknowledgement/Returned as unprocessable claim  The Cl
aim/Encounter has been rejected and has not been entered into the adjudication system St
atus: Missing or invalid information


Is the error we get. Procentive support said it was the group number, but we have called and verified that. Any other ideas?