Every single one of my BCBS and Medica claims have been denied so far.
Medica is denying CO-96, I called them yesterday and was told that the referring physician needs to complete the referral form online at Medica.com. Just so happened we received a new referral for someone who had Medica, I went to their website and was going to complete the referral and the Medica Advantage Plan was not even an option to select to enter a referral. However, with my claims that were denied I was instructed to submit 15 appeals and attach the MD referral/orders. I am about to place another call to Medica and see what answer I get this time.
BCBS, I just spent 2 hours on their website looking for anything I could find on claim submission since customer service couldn’t answer the question as far as episodic or per visit. I billed ours per visit, used T codes originally, they were denied so I submitted corrected claims using G codes, I received back 2 denials yesterday stating that we do not have an authorization, in which we do. The others were denied CO-16, I called customer service and she could not explain to me on 3 separate claims what information was incorrect. So now I wait for another phone call.
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Patti Fladwood
Sent: Tuesday, February 26, 2019 3:06 PM
To: 'billers@list.mnhomecare.org' <billers@list.mnhomecare.org>
Subject: medicare advantage plans
I’m wondering if anyone is having trouble getting paid on the Medica, Healthpartners, and BCBS new advantage plans? Are you billing episodic or per visit? G codes or T codes.
Thank you!
Patti Fladwood
BILLING SUPERVISOR
Optage Homecare, Hospice, and Primary Care
Presbyterian Homes & Services
2845 Hamline Avenue North, Roseville, MN 55113
Tel:(651)631-6198; Email: pfladwood@preshomes.org
Optage® is the home and community services division of Presbyterian Homes & Services.
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