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BCBS

Mardi 2 years ago in Payments/ERA Modules updated by Valerie1 1 year ago 103

Has anyone received payment for services in 2019 from BCBS Blue Plus?

Answer

Answer

There has been much back and fourth on this thread of what everyone is hearing and expressing frustration.  We understand the extremely difficult circumstance you are in and we have been invested in seeking truth with facts on this situation and here is what we have found:

  • - We have had several agencies receive an ERA from Blue Plus (00562) although only professional claims at this point in very small dollar amounts. The ERA payer column will read “BLUE PLUS OF MINNESOTA”
  • - 1/3rd of those agencies have confirmed (we called them) they had an ACH payment into their bank for the exact amount on the ERA. At the top of the ERA when opened, the Method will read ACH.
  • - The agencies who received these EFT/ACH payments DID NOT do anything extra or different with registration, re-processing, etc.


Blue Plus has contracted Amerigroup Health Solutions to process these claims.  Amerigroup is required to abide by the terms from Blue Plus which means you DO NOT need to register, or re-process claims.  If you had ERAs and/or EFT set up before the change it will continue moving forward- no further action required. Blue Plus is aware some agencies have been told they will get a paper check mailed to them but that was an error and should not continue to happen.

We are continuing to run reports daily to track agencies getting ERAs and hope to see this number continue to rise.  We will continue to post updates as we see other improvement. 

I thought it was only the LMN prefix that went to the new payer.  Apparently IDs with prefix JTM are also to be sent to the same payer id

Did you get that info from a rep or from a BCBS bulletin? I do see something from Sep 2018 about Secure Blue MSHO plans that have prefix JTM. And all BCBS Medicaid plans which include PMAP, MN Care and MSC+ are all with LMN. I don't think we have any clients at our clinic with MSHO or MSC+ plans.  Payers transitioning to new processing systems are a disaster!

It was from a claim rejection in the Electronic Module. 

I called on a denial I received on a JTM (MSHO) client.  It was denied as being sent to the wrong contractor.  When I called the rep told me that I needed to send to payer id # 26375. anyone else have seen this issue?  I haven't read anything on this payer id #.

I called yesterday about the same issue and after being transferred 3 times they told me that it is an error in there part and they are reprocessing the claim.

Spoke to Ameriprise, Got a very helpful rep. They  processed an EFT payment for $7567 on 2/16. They confirmed that this is an EFT direct deposit payment and not a check. So it should be showing up any day. 

StephC - To get this information did you call the 866-518-8448 number for Amerigroup?


What I did was once she told me a certain claim was paid I asked her if she could tell me if the payment is part of a bulk payment. She said yes and gave me the bulk amount and EFT number.

At this point I don't know what to believe. I also just got off the phone with Amerigroup and she stated that NO minnesota providers had been up for electronic payment.  She said everyone gets paper checks until they go to this website and enter their information: https://www.caqh.org/solutions/enrollhub

This whole situation would be laughable if it weren't so incompetent.

All of this is very interesting. I still wonder about the accountability of BCBS and DHS to this issue. It is far from the first time that an issue has been caused by BCBS and passed onto providers, be it parity violations (remember the 90837 issue from last year) or the attempted recoupment, or the lack of adding new testing codes,  or the new PCNP underpayment issue, or.....shall we go on? I wonder if they will pay the interest on these claims.....

I agree. When I asked why I received one payment in the form of a check and another payment as an EFT, the rep also told me to contact CAQH. I just chalked that up as a "rep doesn't know what they are talking about" comment and ignored. 

Another weird glitch in my situation: Some early January claims of ours showed as "stuck". The rep said these stuck claims were billed under our group NPI (which they should have as we have a group contract).  The rep is sending them for re-processing. 

The rep said the claims that were paid were processed under an individual providers' NPI, not under our group NPI. To clarify, the rep couldn't find the paid claims until I gave her the individual NPI. Usually, because of our group contracts, reps can only find claims with our group NPI. 

I didn't bill differently among the stuck claims and the paid claims so...?

Amerigroup is in Georgia.

BCBS of Georgia uses CAQH to enroll providers for electronic payments. 

So the reps are programmed to say this to providers who call in. 

They don't realize we're calling about a Minnesota Medicaid product through BCBS.

Just my guess....?

Yes the 866-518-8448 is the number to call

I just had a long talk with someone from DHS.  They agreed that at the very least, the communication needs to improve and that they would try to get some answers from DHS.

Good Morning Community,

I've been following this thread. This has become a very challenging event to manage since it impacts our monetary budgets immensely. We called Amerigroup earlier this morning 8:20am CST. There were no hold times. We spoke to a very apologetic CSR who was kind and very helpful. We inquired about our early January 2019 claims. She informed us they were received. There was a configuration issue on their end which recently was resolved. Again, the CSR was very apologetic and reassured us claims were being processed and paid but it will take time to manage the enormity of this event. The CSR advised if you have not done so yet, please send early January claims again. Amerigroup would not deny or reject these submissions as duplicates. 

Our office was ahead of the pack and resent all of our January claims around Jan 21. We will not be resending claims a third time as it will compound what is happening at Amerigroup.

I realize these comments cannot deliver money to the bank however, for us, it gives us hope Amerigroup has resolved the issue and they are slowly managing their way through a very serious-challenging situation. 

Debbie

Did they happen to mention a date that the claims should have been resent? I resent ours on 1/17/19. 

Thanks to all for making the calls to get this figured out!

KLatham,

If you resent your claims on 1/17, you should be fine. I resent mine around the same time. 

Debbie

+1

So is there a common understanding about payment method? Do we need to do the EFT process over again? Paper checks?

Answer

There has been much back and fourth on this thread of what everyone is hearing and expressing frustration.  We understand the extremely difficult circumstance you are in and we have been invested in seeking truth with facts on this situation and here is what we have found:

  • - We have had several agencies receive an ERA from Blue Plus (00562) although only professional claims at this point in very small dollar amounts. The ERA payer column will read “BLUE PLUS OF MINNESOTA”
  • - 1/3rd of those agencies have confirmed (we called them) they had an ACH payment into their bank for the exact amount on the ERA. At the top of the ERA when opened, the Method will read ACH.
  • - The agencies who received these EFT/ACH payments DID NOT do anything extra or different with registration, re-processing, etc.


Blue Plus has contracted Amerigroup Health Solutions to process these claims.  Amerigroup is required to abide by the terms from Blue Plus which means you DO NOT need to register, or re-process claims.  If you had ERAs and/or EFT set up before the change it will continue moving forward- no further action required. Blue Plus is aware some agencies have been told they will get a paper check mailed to them but that was an error and should not continue to happen.

We are continuing to run reports daily to track agencies getting ERAs and hope to see this number continue to rise.  We will continue to post updates as we see other improvement. 

Was there an estimate on institutional claims payments?  We have not received any payments on our SUDS claims.

Thank you Alicia Swanson for clearing the air. We appreciate all the support. 

Debbie

+1

Pro Community,

This morning in our ERA system is payment from BCBS PMAP, over $13,000. 

FYI

This morning our ERA also had a BCBS Pmap that paid.  Hope everyone else gets something good in their ERA's today also!

We haven't received any payment for institutional claims yet.  Any insight on this?

Good morning,

Yes, I'm seeing activity, payment arrived in the ERA system this morning.

HOWEVER - please pay close attention the rates being paid. I'm seeing major inconsistencies with payment on the same CPT code, same client, same therapist, different DOS. It's happening with more than one CPT code, with multiple DOS, with multiple clients. 

I am processing a very large BCBS PLUS remit and then going back to review this in more detail. Concerning indeed.

Debbie

We also have not had any payment on our institutional claims and it is starting to add up quickly.  Has anyone had any luck with payments on institutional claims?

I, also, received a large Blueplus payment in our ERA module and in our bank today. 

I, also, see they are sometimes paying $45 more than what I would expect on 90837 codes with any kind of modifier: GT or HN. 

We got a large ERA from Blue Plus today, maybe a third of the amount of our unpaid claims to date. This is good news, however, interest paid was pretty low...53 cents, I feel like it should be more. I'll be checking rates as well since others have seen discrepancies. 

We received a Remit and Payment today as well.

WOW, error rate is very Large.

I have already called Blus Plus and started getting claims "sent back" for reprocessing.

Spoke to a rep in the Virginia Beach VA location, she seemed to be pretty knowledgeable


Due to the large number of issues on this ERA the she then created a "project" for the whole remit.  This Project will have a each line item reviewed within the ERA.  I received a call reference # but will need to call back to get my Project # / Appeal #. 

This ERA has almost 900 claims in it and I had only looked at the clients with last names starting with A & B (70 claims) and found 20 errors. 

Thought this information might be helpful to others.

What codes or services does your clinic provider? I looked through my remit and different clients and did not find any differences in payment from 2018 to 2019. 

We noticed a .01 increase for a 90837, most likely a rounding varience

I contacted the Senior Network Management Officer at BCBS about the overpayments on modifier claims. He said Amerigroup is aware and working on correcting it. 


We bill

mostly 90837/90834

But also H2014 / H2019

So far most errors were for 90837

Some were regular 90837 some were 90837 UA (CTSS clients)

I had multiple examples when the client was paid 3 different rates for same code.

(Payment errors were from $32.00 to $82 short per DOS)


I looked on our huge ERA payment, and there were many underpaid 9 codes as well.  I will have to call and see what they say about this frustrating issue.  

I was wondering.. has anyone been able to check claim status anywhere?  We do not have a drop down for Blue Plus on Availity.  Also-where are we supposed to send appeals and/or claim reconsideration requests?  What a MESS!

How to check 2019 BP claims on Availity:

I called Availity and found out how to check 2019 claims:

You have to go to the “New Claim status inquiry” field.

For MH, Armhs and CTSS under NPI, you have to enter the rendering provider’s NPI (or supervisor’s NPI if the staff is under supervision). It doesn’t pull anything up if you use agency NPI.

I received a check in the mail on 2.25.19 but it was cut from BCBS on 2.19.19. To date I have not received a actual ERA in Procentive and no detail came with the check which was mailed not directly deposited. How long does this take, I see some of you have received some directly deposited and some haven't and some have the ERA filter into Procentive. I am unable to locate a ERA online anywhere on Availity. 

+1

Has anyone received payment on Institutional billing.  I haven't received any payments on my SUDS billing.  Or if anyone knows the trick to look up BP on Availity for institutional billing that would be awesome!

Amy you may have better luck calling them at 866-518-8448 if you have the check number and amount they may be able to email or fax you the remit.  Or let you know when to expect the remit in the mail.

We received a physical check (for two claims - very small) in our 2/19/2019 mail, with a printed date of 2/12/2019. BillCare received that ERA on 02/12/2019. We received an EFT in our bank account on 02/23/2019 (a more substantial amount) which an Amerigroup rep. told me was posted in their system on 02/16/2019. It seems as though their payments are one week behind their ERA's. We have not received any additional payments/EFT's/ERA's.

I called Amerigroup and they are faxing me a copy of the remit. I thought it was suppose to be all set up in Procentive, I may just have to do a ticket. I'm just glad I called and was able to get a copy...

I called Amerigroup in regard to the institutional claims and the rep I spoke to said they have 90 days to pay from the date of submission.  I also figured out how to look up Institutional claims in Availity.  When you are inquiring at the bottom of the page for type of bill put 891 and it will give you the claim status.

I did share these concerns with DHS.  They were forwarded to the BCBS contract manager who called BCBS.  BCBS then called me the next day.  Not a lot has changed, but I did make some noise to the right people.

Thank you for contacting DHS!

@tbelcher, did you just call the DHS Provider Line (651.431.2700) and speak with someone, or do you have another more direct phone #? we would like to call them too to share our concern!

Except for a payment last week from BCBS PMAP, we have seen nothing come through today paying for all the backdated claims for this PMAP. And there is a lot of money out there to be paid. Has anyone seen a check come through today paying for these PMAP invoices? 

Is there anyone out there who has not received ANY payment in 2019? We are still waiting for our first dime. When I called on Friday, I was told that claims that had not been processed by February 28th were going to have interest added. When I look up our claims on Availity, it says all my claims that I sent out (which the earliest was Jan. 18th) say N/A. We are a small organization, and will not be able to hold out too much longer without some type of payment. I can't seem to get any consistent answers from Blue Plus or Availity.

We have only received one real payment from BluePlus for the year, but it was for about 1/10 what we have billed. Nothing since mid-February.

Thanks for the response, Sarah. Not that it makes it any easier that we aren't getting paid, but I am thankful it just isn't our agency that hasn't received another check for the PMAP clients.  

How do we find out who our Contract Manager is for BCBS Pmap claims?

I am calling and calling and no one can get me to the correct person that can help me. 

Our ONE AND ONLY remit/payment has over 200 errors.

Our one ERA payment had lots and lots of errors as well--underpaid 9 codes. I don't know how you go about finding out who your contract manager is, but ours was contacted about what to do with all these errors and our contract manager was going to look into it.  Initially we were told our claims were sent to the wrong 5-digit electronic invoice, (which earlier claims had been up until that 1-14-19 date, then all resent to the correct payer) and that is the last we have heard.  I don't know what needs to be done with these underpaid claims yet either.  

I just asked my network manager at BCBS, about all of this and this is the response I got from him: 


Hi Alyson,

The only info we have been given from Amerigroup is the following:

Behavioral Health claims account for 26% of pended inventory – we expect the institutional claims related to BH as well as many of the professional to pay the weekend of 3/2.  There will remain some targeted holds on certain procedure codes and modifiers that are still being corrected for appropriate pricing.

Got this from my network manager at BCBS today:

Hi Alyson,

We got advised that most of the payments (that were paid out yesterday) were for CD facility locations being and not the BH clinic psychotherapy codes. They (Amerigroup) advised those will be processed this weekend and should start to be paid by next week. If that changes I can let you know as I get more info.

From what I have been advised the hold up on the claims seem to stem from the wanting to get the pricing correct the initial processing time to prevent many recovery projects for overpayments that have happened in the past.

We have received larger payments now for our clients, but again, it seems that we are being paid less for 9 codes, especially the CTSS (UA) 9 codes. Is anyone else finding this to be true? 

AHaugen

We are not getting paid correctly for 9 codes for CTSS clients either.

Kim 

I was wondering if anyone has received their MHCP ERA that was issued on Monday. Thanks 

Did the funds get deposited into your bank account? 

We have not. Have been checking and checking, but the ERA hasn't come through yet, though MN-ITS shows a payment.

Thanks I have been doing the same.

Has anyone had any luck pulling a Remit for Blue Plus of Minnesota? ive tried Avality to no avail. Amerigroup i get a sign on error, no matter what i try.

Saw today from our bookkeeper that the MN ERA got deposited in our account today, but still have not seen the Remit come through to apply.

I just spoke with a rep at Amerigroup and the MN MH claims are still processing, no ETA.  We are a small company and have over 40 claims over 30 day old.  This is getting ridiculous. 

We still haven't gotten payments.  Has anyone gotten correct ones?  We got a couple trickle in for new DOS but nothing yet for older ones