I have no idea if this will help but I have had my own issues with Medica EW claims, some were paid and now they are not paying and they keep telling me it’s an address issue. They supposedly fixed that issue but the claims keep denying.
This is a contact I was given and I got the most help but now since my issue is not resolved I contacted them again on Monday and still no response so you can try and hopefully they will respond and get you in the right direction.
MedicaDemoResolution@medica.com
Thanks,
Melissa Austreng
Home Care and Housing Biller
|
|
Assumption Community 715 1st Street North Cold Spring, MN 56320 |
Phone:
320.348.2358
Email:
austreng.melissa@assumptionhome.com
Web:
www.assumptioncommunity.com
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Patti Fladwood
Sent: Wednesday, June 16, 2021 2:18 PM
To: billers@list.mnhomecare.org
Subject: RE: Medica and Optum VA
I was on the phone with CS at Medica yesterday for over an hour…..they had no clue what the claim was denied for. When I asked to speak with a claims processing manager, of course they could not do that. She gave me a referral number
and said someone would contact me within 30 days☹ I was just about hyperventilating when I got off the phone. Does anyone have a contact with someone at Medica that could give some answers???
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Dougherty, Sarah J
Sent: Wednesday, June 16, 2021 2:14 PM
To: billers@list.mnhomecare.org
Subject: RE: Medica and Optum VA
Hello,
I am also having issue with Medica The Advantage Solutions plan.
The claims that span the 2020 / 2021 calendar year
2020 Payer ID 94265
2021 Payer ID MEDM1
I billed Payer ID 94265 with the Statement date spanning 2020/2021 Cal Yr and with a HIPPS code.
Medica paid the 2020 DOS and denied the 2021 DOS after term date.
Then billed the same claim to Payer ID MEDMI
I was told today only the 2021 Date Span can be billed to MEDMI, the 2021 Date span needs to be split
The HIPPS code however is a 2020 Service date. Though Medica does not pay on the HIPPS code they always say they are following Medicare guidelines.
Has anyone figured out how to get the 2021 charges paid with a SOC in 2020?
I think Medica is paying 2021 MEDM1 Payer ID claims under PDGM guidelines (30 day episodes, PDGM HIPPS code) though this is unconfirmed)
Thank you
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Sent: Tuesday, June 15, 2021 12:54 PM
To: billers@list.mnhomecare.org
Subject: [External Mail] RE: Medica and Optum VA
CAUTION: This email originated from outside of the Allina Health network. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Thank you so much for the feedback! This has been extremely frustrating!!
I have it escalated, as I also have some claims that are paying with Occ code 50 but no Rev code, and some that are denying, so there is really no rhyme or reason to one or the other, or guidance to back anything up!
I’m just happy to know that I wasn’t missing a provider letter or something stating the billing guidelines are changing for those plans.
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Patti Fladwood
Sent: Tuesday, June 15, 2021 12:18 PM
To: billers@list.mnhomecare.org
Subject: RE: Medica and Optum VA
Same issue here. Now I’m told they also want the MSA and FIPS code!
From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mary Hanson
Sent: Tuesday, June 15, 2021 11:52 AM
To: billers@list.mnhomecare.org
Subject: RE: Medica and Optum VA
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.
CONFIDENTIALITY NOTICE: This message (including any attachments) may contain confidential client information.
The information is intended only for the use of the individual or entity to whom it is addressed. If you're not the addressee or the employee or agent responsible to deliver this e-mail to its intended recipient, you are hereby notified that any review, use,
dissemination, distribution, disclosure, copying or taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this communication in error, please notify the sender immediately, delete this message from
your computer and ask your network administrator to delete it from any storage or back up files.
This electronic securemail transmission (including any attachments) may contain confidential health or other information that is protected by law. It is not intended for
transmission to, or receipt by, any unauthorized persons. If you have received this electronic mail transmission in error, please delete it, and notify the sender by reply electronic mail transmission so that our records can be corrected.
CONFIDENTIALITY NOTICE: This message (including any attachments) may contain confidential client information.
The information is intended only for the use of the individual or entity to whom it is addressed. If you're not the addressee or the employee or agent responsible to deliver this e-mail to its intended recipient, you are hereby notified that any review, use,
dissemination, distribution, disclosure, copying or taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this communication in error, please notify the sender immediately, delete this message from
your computer and ask your network administrator to delete it from any storage or back up files.
This message contains information that is confidential and may be privileged. Unless you are the addressee (or authorized to receive for the addressee), you may not use, copy or disclose to anyone the message or any information contained in the message. If
you have received the message in error, please advise the sender by reply e-mail and delete the message.