I have had to bill each month separately for the Media Advantage claims. You might have to try billing 2021 as a separate claim from you 2020 charges.

Marnie

Lakewood Health System Home Health & Hospice

218 894 8324

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

**External Sender**

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 1^st 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

www.gaehomecarehospice.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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