UCare PMAP denying UA modifiers

Kayla Kenworthy 6 years ago in Billing/Electronic Modules updated by Shauna Dall 6 years ago 7

I've been noticing the last few Ucare PMAP ERA's have been denying every claim with a "UA" modifier. Is it something I'm doing wrong, or is it an issue with UCare? Anyone else been having these issues?

I had problems with codes H0032 UA UD and H0031 UA UD and I called and they told me that it was coming in as 99 which I was puzzled, after I finished speaking to the rep she said to try and submit H0032 UA and H0031 UA and that worked for me.

Doesn't the UD on those codes mean something specific to CTSS? Does submitting then as H0032 UA mean something else?

The UA means it is CTSS. The UD must mean something different, depending on its placement in the code. The ARMHS codes are H0031 UD and H0021 UD TS and then H0032 UD and H0032 UD TS. The TS signifies it is a review, and not the original - in regard to the ARMHS codes.

Is it definitely the UCare PMAP? We have a few clients who have UCare, but it's the UCare Choices plan. That doesn't cover any CTSS codes as far as I can tell.

I believe so. The CARC is 6: The procedure/revenue code is inconsistent with the patient's age. The patient's are minors

I wonder if their system is taking the UD modifier first, and thinking it is an ARMHS Treatment Plan or Functional Assessment? That would explain the age denial. BCBS had some trouble last year with their UA codes and U1 codes. They were processing our DBT U1 modifiers as UA modifiers. Hopefully it's just a programming glitch that they can fix quickly.

I believe UD mod in MN is an eval/case review by a non-physician.

We are not having lots of issues re: PW or UCare paying for these codes, I just ran a full report.  Could it possibly be that when the rep stated it was coming in as a 99 she meant place of service (99) Other?  Because Tx Plan reviews occasionally take place in an office setting, and office is not an acceptable POS for CTSS billing, did the provider or anyone use the (99) Other location?   We have run into denials on this code for this reason with Blue Plus also.

We have advised staff that if they routinely see a client in Home or School, their POS should be Home or School for the CTSS H0032 UA UD code/Tx Plan Development.  I'm not sure about ARHMS billing or if you are having issues there also.