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Direct Access and Authorizations

Jason L 3 weeks ago in Billing/Electronic Modules updated by Chris Werner (Customer Success Manager) 1 day ago 9

Thought this might be helpful... I've added the authorization # of 88888888888 to the authorization field for our MA payer and submitted claims for Direct Access services, and they show as set to pay. I know from talking with others there were ideas around adding a new payer in order to accommodate one payer that can include authorization numbers on claims (Rule 25 clients with SA #s) and a separate payer that can exclude authorization numbers on claims (Direct Access clients)..

DAANES authorization numbers default to 8888888888 and using that on claims seems like it will work, allowing one MA payer, where Rule 25 clients can have actual SA #s (as they always did) and Direct Access clients can have the default authorization number of 88888888888.

Is this for inpatient claims also or just for outpatient?  

Inpatient claims require a Value Code that has not been set up on Procentives end that I am aware of.

Hi Jen,


Ultimately, the same should apply to both, as it relates to the auth number. The value code issue is separate, and one Procentive has not figured out. I also asked for an update again earlier this week. I'm going to test a residential claim through MN-ITS, with the auth # of all 8s and see what happens.

Hi Jason,

We tried your tip yesterday and this morning MNITS is showing it has denied. 

When you look it MNITS it shows as paid but the amount is $0.00. Are you seeing that they are going to be paying the BHF rates?

Jeremy

Do you have the DAANES entry updated with the service code you billed? They are paying in full, yep.

Hi Jason,

We also had a claim deny with the 8s in the auth line.  I had Angie at DAANES verify that the DAANES record is correct for direct access, and I called the DHS provider line and they advised to remove it and rebill, which did correct the issue and result in a paid claim.

It looks like they may have updated their system to disallow anything in that field unfortunately.

Alicia

DHS also told me they "thought" any entry would cause a denial, though the claims we've sent have all paid. We'll be sending our weekly claims tomorrow, so I'll circle back with the results.

We billed claims with 88888888888 in the authorization field again this week and they continue to pay. Anyone else try and have success?

Thank you everyone for your information.  We have an update coming soon to Procentive to accommodate for Value 24 coding.  Please visit our Live Updates page for more information.


Take care! 

You are now able to add a Value 24 code within Procentive.  Please visit our Live Updates page for a link on how to set up these codes in your payers.

Thank you!