0
Fixed

UCare Claim Rejection

Amanda Kaufmann (Customer Success Manager) 2 years ago in Billing/Electronic Modules updated 2 years ago 14 1 duplicate

Hello, 

We have been made aware of the issue in regards to claim rejections occurring in the Electronic Module for UCare claims submitted to the payer ID 52629. 

We are currently working with the clearing house, and payer in order to determine what the cause of the rejection is on their end. Please hold off on submitting claims at this time. We will alert you when we receive a resolution and determine if all claims need to be re-sent at that time. 

Thank you,

Amanda Kafumann

Customer Care and Training Specialist 

Answer

Answer
Fixed

Hello, 

The clearing house and UCare have worked together to resolve the issue that occurred when sending claims to UCare Payer ID 52629. Due to this issue, all claims that were previously submitted then rejected will need to be re-submitted. 

Thank you,

Amanda Kaufmann

Customer Care & Training Specialist 

Duplicates 1

I believe that Ucare asked providers to hold their claims.


2019 Electronic Data Interchange Claims Delays for UCare Individual & Family Plans: As UCare prepares to transition to its new claims adjudication system for Individual & Family Plans, additional time is needed to test and ensure all connections are ready for claims processing. UCare is requesting that providers begin sending claims with dates of service in 2019 on or after Jan. 10, 2019, for Individual & Family Plan members ONLY. Claims for 2018 dates of service and all other lines of business are unaffected.

All my claims have Rejections that I have submitted this year.  Is this the reason?  Should I re-submit next week when the problem is fixed?

maybe this is why. Not sure. I have not billed claims for 2019 yet.

I have sent in tickets to Procentive today and have not gotten a response.  The tickets don't have the "received" message 

Searching answer

Hello, 

We have been made aware of the issue in regards to claim rejections occurring in the Electronic Module for UCare claims submitted to the payer ID 52629. 

We are currently working with the clearing house, and payer in order to determine what the cause of the rejection is on their end. Please hold off on submitting claims at this time. We will alert you when we receive a resolution and determine if all claims need to be re-sent at that time. 

Thank you,

Amanda Kafumann

Customer Care and Training Specialist 

Searching answer

UCare Update:

At this time we still do not have an ETA for the fix between UCare and the Clearing House. If you would like to continue sending your claims, the payer may be able to reprocess them on their end. We are continuing to work with our resources to obtain an update, and will be sure to let everyone know when the fix has been put in place. 

Continue sending claims, however know you will still receive the rejection at this time. We hope to know when this is resolved if you will need to resend claims manually or if the payer will re process for you. 

Thank you,

Amanda Kaufmann

+1

In reviewing the newsletters I have received from UCare, could the snippet below be an indication of why the Payer ID is not working through Procentive?  I believe 52629 was the pre-1/1/2019 number....just a thought...

NEW Payor ID: 55413
The Payor ID for all UCare Individual & Family Plans will change to (55413) for electronic claims
submitted with dates of service (DOS) on and after January 1, 2019. Providers should contact their
clearinghouse to confirm the new Payer ID for this plan — as other clearinghouses may assign their own
unique number.
Claims for members with these products that are not submitted to the new Payor ID on or after January
1, 2019, will be rejected. The reason for the rejection will be one of the following:
 Entity not eligible for benefits for submitted dates of service
 Subscriber not found
 Member cannot be identified

All of the claims I'm submitting are PMAP UCare.  I am using the old Payer ID of 52629 with these and they are still being rejected. None of our clients have the Commercial UCare Individual and & Family Plans that are using the new ID of 55413.

So I'm wondering why I'm still having this problem?   I can still use the old Payer ID with the PMAPs, can't I?

thanks for any insight!

Kathy - I'm experiencing the same issue. All UCare PMAP claims; while non Commercial Ind and Family Plans. 

Debbie

As am I, All mine are also Pmap

Hello, 

This issue is pertaining to the payer ID 52629 which is for both PMAP and Commercial UCare plans

The new ID of 55413 is for Individual and Family plans, which will go live tomorrow 1.10. 

Please look for further communication on this post by mid-day tomorrow. We hope to have new information in the next business day from the clearing house. 

Thank you,

Amanda 

All of my UCare claims went through

Answer
Fixed

Hello, 

The clearing house and UCare have worked together to resolve the issue that occurred when sending claims to UCare Payer ID 52629. Due to this issue, all claims that were previously submitted then rejected will need to be re-submitted. 

Thank you,

Amanda Kaufmann

Customer Care & Training Specialist