I am having the same issue with MEDM1. I am not billing pdgm. They were paying once I started including Occurrence code 50 but now they are denying stating they need Rev code 0023. It appears random because for one particular client they paid some, then denied a few in the middle, and then paid some again without any change in how I am billing. I am working with our software company and found a way to hipps with the Rev Code 0023 without billing episodic. I am waiting to see if they pay.
It is almost like they are wanting some pdgm components but not all. Very frustrating!
Mary Hanson | Billing Specialist | River Valley Home Care Inc.
916 8th Street Farmington, MN 55024
Phone: 651-460-4201
Email: mhanson@rvhci.com
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Sent: Tuesday, June 15, 2021 11:05 AM
To: billers@list.mnhomecare.org
Subject: Medica and Optum VA
Good morning!
Is anyone having issues with Medica claims with the new payor ID MEDM1? We are receiving denials, stating Occurrence code 50 is required on the claims. I have sent claims back with Occurrence code 50, and then they deny for no Rev code 0023. We have not received any provider guidance that billing requirements have changed for this plan, or at least I’m not seeing anything, and no other Medica Adv plans are billed this way, nor have ever been.
Optum VA claims are also denying if they do not have the Occurrence code 50 on claims, and this started happening around Feb 1st of this year. I’m also not seeing any provider guidance on that, or any changes in billing requirements.
Feedback appreciated!
Thanks!
Be Compassionate. Be Accountable. Be Respectful. Be Excellent!
Jessica DeMarais
Claims Specialist
Guardian Angels Elim Home Care and Hospice
403 Main Street, Elk River, MN 55330
Direct 763-452-4163
Main 763-241-0654
Fax 763-241-0274
Email jdemarais@gaehc.org
Guardian Angels † Elim Home Care & Hospice is jointly owned by Guardian Angels Senior Services and Cassia, an Augustana/Elim affiliation.
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