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MN PAYER CHANGES for BCBS PMAP --SCHA -- UCARE

Rachael Smith (Care Team Manager) 1 year ago in Payers Module updated by Amanda Kaufmann (Customer Success Manager) 1 year ago 4

The Minnesota payers BCBS/Blue Plus, SCHA/MMSI, and UCare are making updates within the next 2 months.  We will provide you with more details mid-November, but here’s what you should do now: 

Blue Plus PMAP (of MN)

The Change: 

  • BCBS is creating a new Payer ID number for Blue Plus PMAP to distinguish it from Blue Plus Commercial plans.
  • As of December 1st, 2018, all PMAP claims will need to be submitted to a new Payer ID number.
  • Procentive will automatically update the Payer ID in the new payer Blue Plus PMAP on December 1, 2018.

Action Required: 

  • Add the new payer "Blue Plus PMAP" (ID: SB720) to the Payers Module. Copy over current codes and rates from the BCBS PMAP payer.
  • Add the new payer to each client that has BCBS PMAP and begin using this new payer right away.  (Run Report 3070 in the Reports Module to see a list of all clients with BCBS PMAP.)
  • Inactivate the old BCBS payer for each client as you add the new one. 


SCHA/MMSI

The Change: 

  • SCHA/MMSI’s Payer ID will change as of December 1, 2018.

Action Required:

  • Fill out the Electronic Funds Transfer (EFT) form you receive from SCHA/MMSI.  
  • DO NOT fill out the Electronic Remittance Advice (ERA) form that they send you.  
  • At this time no change within Procentive is needed. 


UCare

The Change: 

  • UCare is creating a new Payer ID for UCare Family and Individual (currently called either UCare Choices or Fairview UCare Choices), effective as of January 1, 2019.
  • Procentive will automatically update the Payer ID in the new payer UCare Family and Individual on January 1, 2019.

Action Required: 

  • Add the new payer "UCare Family and Individual" (ID: 52629) to the Payers Module. Copy over current codes and rates. 
  • Add the new payer to each client that currently has either UCare Choices or Fairview UCare Choices. (Run Report 3070 in the Reports Module to see a list of all clients with these payers.)
  • You will need both the old and new payers for a client because the payer you submit to will depend on the Date of Service.  


Have further questions on what to do to prepare for these changes? Please submit a ticket to the Procentive Care Team.

Answer

Answer

Minnesota Blue Plus PMAP 2019 Payer ID 00562 Update

We are aware of the issue with the incorrect Payer ID being sent on claims for some agencies. Upon further research into this for you this morning, we have determined the cause to be one of the following:

Option one– The original communication was missed regarding this change and the Blue Plus PMAP payer you have in your payers module is still set to the old Payer ID of SB720/00720.
SOLUTION– 1. Add the new payer with the payer ID 00562 for all Minnesota Blue Plus PMAP plans and copy over current codes and rates
from the BCBS PMAP payer.
2. Add the new payer to each client that had BCBS PMAP and begin using this new payer right away.

Option two– If the above is complete and you are still receiving denials then it is due to Procentive allowing them to be sent to the old payer ID. We have already fixed this to prevent this from happening as of 10:00 am cst today.
SOLUTION– Resend any 2019 claims which were previously sent prior to 10:00 am cst on 1/14/19.

If you have questions, please create a ticket so the Care Team may assist.

Thank you,

Amanda Kaufmann

Customer Care & Training Specialist 

    We’d like to provide you with some additional information regarding the instructions on the upcoming payer changes we emailed you about recently. Please review the following:

    Blue Plus PMAP (of MN)

    If your agency already has two BCBS payers (BCBS PMAP and BCBS Commercial), the Procentive Care Team can update your BCBS PMAP to the new Blue Plus PMAP for you. 

    Submit a support ticket to Procentive Care Team as quickly as possible, and we will make this change in your database.

    UCare

    We’ve created this Knowledge Hub article with all the information you need to make the upcoming transition from UCare Choices to UCare Family and Individual on January 1, 2019.

    This transition could have implications for your revenue stream. Please review the article provided and follow the steps outlined there to make sure you are adequately prepared prior to January 1.


    Learn More

    After reading the Knowledge Hub article, if you need any further clarification, please send a ticket to Procentive Care Team. We’re happy to guide you through this rather significant change.

    Update for SCHA Payer Changes


    The Change

    As of 1/1/2019 Mayo Management also known as MMSI will no longer be processing claims for South Country Health Alliance also known as SCHA.  If you submit claims to SCHA, you will need to complete the following actions:

    Action Required

    Create a new payer in the Payers Module labeled SCHA.

    • When creating this new payer, use the Payer ID 81600 > South County.
    • Remember to copy all of your codes and setup from the MMSI payer to this new payer.

    Re-label your original SCHA/MMSI payer to MMSI.
    Assign all SCHA clients to the new SCHA payer.

    • To determine which clients are SCHA, you will need to check their insurance card or call the payer directly.

    Complete the EFT paperwork you have received from SCHA

    • Do not complete ERA paperwork. Procentive is doing this for you.  

    Helpful Tips

    • If you already have separate MMSI and SCHA payers in your database, please send a ticket to Procentive, and Customer Care will update your SCHA payer to the new payer ID.
    • You can begin to submit claims to the new payer ID immediately through Claim Lynx. The payer has given a deadline of 1/1/2019 to switch your SCHA clients to the new payer ID.
    • Procentive will submit ERA Applications for all agencies that have the Payer ID 81600 in their database. No additional action required.

    Update for Blue Plus Payer ID 


    The Change

    As of January 1, 2019, Blue Plus PMAP will change their payment processor to Amerigroup and will have a new Payer ID (00562) . You will need to submit all claims for dates of service (DOS) on or after 1/1/2019 to this new Payer ID. 

    Action Required

    We’ve created this Knowledge Hub article with all the information you need to make the upcoming change to the Blue Plus PMAP payer for January 1, 2019. 

    This transition could have implications for your revenue stream. Please review the article provided and follow the steps outlined there to make sure you are adequately prepared prior to January 1.

    Blue Plus PMAP Payer ID Change on 1.1.2019

    After reading the Knowledge Hub article, if you need any further clarification, please send a ticket to Procentive Care Team. We’re happy to guide you through this rather significant change.

    Thank you,

    Rachael Smith

    Onboarding and Implementation Team Manager


    Answer

    Minnesota Blue Plus PMAP 2019 Payer ID 00562 Update

    We are aware of the issue with the incorrect Payer ID being sent on claims for some agencies. Upon further research into this for you this morning, we have determined the cause to be one of the following:

    Option one– The original communication was missed regarding this change and the Blue Plus PMAP payer you have in your payers module is still set to the old Payer ID of SB720/00720.
    SOLUTION– 1. Add the new payer with the payer ID 00562 for all Minnesota Blue Plus PMAP plans and copy over current codes and rates
    from the BCBS PMAP payer.
    2. Add the new payer to each client that had BCBS PMAP and begin using this new payer right away.

    Option two– If the above is complete and you are still receiving denials then it is due to Procentive allowing them to be sent to the old payer ID. We have already fixed this to prevent this from happening as of 10:00 am cst today.
    SOLUTION– Resend any 2019 claims which were previously sent prior to 10:00 am cst on 1/14/19.

    If you have questions, please create a ticket so the Care Team may assist.

    Thank you,

    Amanda Kaufmann

    Customer Care & Training Specialist