Procentive News

  • Tricare West ERA Application

    AUGUST 26, 2014

    We are pleased to announce that you may now receive ERAs for Tricare West claims. We have attached the ERA application with instructions on how to complete the application. Once the application has been filled out and faxed to Tricare you will then be able to receive ERA’s in Procentive for easier posting of payments.

    Download

    Tricare West ERA Application Form

    Application Instructions

     

    This application must be completed by a staff member that has signing authority. All completed applications MUST be faxed to be Tricare and Procentive.


    1.  Download the ERA application PDF (see below)

    2. On page 2 “ERA Enrollment Form” please complete the following fields:


    ·  Provider Information: Enter in your company name as it appears on your tax

    ·  Provider Address: Enter in your billing address.

    ·  Provider Identifiers Information: Enter in your group Tax ID and group NPI only. Please leave the “Other identifier(s)” and “Trading Partner ID” fields as is.

    -In the “NOTE:” section, please place a check in the box.
    -Do not complete the “Tricare Provider Number”, “National Provider Identifier (NPI)”, or the “Business Name and Address” fields.


    ·  Provider Contact Information: Please enter in the name of the staff name and phone number that should be contacted if there are any questions or concerns about the application.


    3. On page 3, please complete the following fields:


    ·  Email Address: Enter the email for the contact staff from page 2.

    ·  Fax Number: Enter in the fax number for the contact staff from page 2.

    ·  Electronic Remittance Advice Information: In the “Provider tax identification number (TIN) or National Provider Number (NPI)” field, please enter your group NPI. Please leave all other fields as is and go to the bottom of page 3.

    ·  Authorized Signature: Type/write in the signature of the person submitting this form (this must be a staff that has authority to sign applications for payers), enter their title (CEO, Business Manager, Owner, etc.), the submission date (date you are faxing the application), and “Requested ERA Effective Date” this must be the same date as the submission date. ERAs cannot be backdated.


    4. Pages 4 & 5 contain more detailed definitions of the fields, if needed.

    5. Once the application is complete, please fax the following:


    All 5 pages to:

    PGBA, LLC

    Attn: Tricare EDI

    Fax # 803-264-9864.


    A copy to:

    Procentive

    Attn: Jessica

    Fax #888-354-9053 (or attach the application to a ticket)

    If you have any questions about the application please submit a help desk ticket. Please allow up to 6 weeks from the time of submission for ERAs to appear in Procentive.

    Download

    Tricare West ERA Application Form

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  • DSM 5 Release

    AUGUST 15, 2014

    Starting Friday, 8/15, Standard Procentive forms sets will include a DSM 5 section in the documentation.  Please see the following forms listed below:

     

    • T120010 Minnesota CTSS Diagnostic Assessment
    • T120011 MN CTSS Diagnostic Assessment
    • T120050 Standard Diagnostic Assessment
    • T120055 Standard Diagnostic Assessment – NEW
    • T120150 Standard MH Diagnostic Assessment
    • T120155 Standard MH Diagnostic Update
    • T120200 CTSS Diagnostic Assessment – Provider
    • T120400 BHP Discharge Summary
    • T120031 MN CTSS Individual Treatment Plan
    • T120075 Standard Individual Treatment Plan-NEW
    • T120070 Standard Individual Treatment Plan
    • T120030 Minnesota CTSS Individual Treatment Plan
    • M150110 Chem Dep Comprehensive Assessment Summary


    The DSM-IV will also continue to be present on the documents as well so that your staff can begin to transition. The DSM-IV and DSM 5 will only appear on the printed version if they are filled out or information has been entered.

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