I am having a difficult time getting two of our claims paid, One is a BCBS Medicare Advantage claim from the beginning of the year, and the other one is a Blue Plus MSHO – Medicare portion claim. You are not
alone. L
Marnie
From: billers@list.mnhomecare.org [mailto:billers@list.mnhomecare.org]
On Behalf Of Salin, Tracy
Sent: Wednesday, August 28, 2019 9:23 AM
To: billers@list.mnhomecare.org
Subject: RE: A few insurance questions
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The only one I can tell you is, on the BC MSHO, if medicare we bill PPS and they pay the rap and claim the same as medicare. If MA side, we bill visits. This has been working for us. IS HP Health Partners?
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Jennifer Larsen
Sent: Tuesday, August 27, 2019 2:29 PM
To: billers@list.mnhomecare.org
Subject: A few insurance questions
Hi all, I have a few questions I am hoping to get some answers. The 2 payors below are still 2 I struggle with so I am hoping one of you has had successes and can share them.
HP MC ADVANTAGE – Per our contract manager, these are billed PPS, they don’t need or make payment on the RAP and will make payment on the FC. Has anyone had more than 1 success in receiving payment?
HP MSHO – PPS or FFS? If PPS, do they only pay the FC?
BLUE PLUS MSHO- PPS or FFS? If PPS, do they pay on RAP and FC?
BCBS MC ADV- I am still getting my RAP taken back when I submit my FC and receive a denial that I billed an invalid replacement claim. Any successes in getting paid and not having to call customer service to reprocess?
As always, thank you so much for your help through this email group!
Jennifer Larsen
Claims Specialist
Guardian Angels Elim Home Care and Hospice
403 Main Street, Elk River, MN 55330
Main 763-241-0654
Direct 763-452-4101
Email
jlarsen@gaehc.org
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