I have not had a problem with getting the MedM1 claims paid.  I have to jump thru a lot of hoops, though. 

Box 31 - 50 occurrence code and the date the recert/soc was done

Box 39 -  61 in the value code area with 33460.00 (if that is the CBSA CODE for your area)

Box 40 - 85 in the second value code area with the FIPS county code.

I use the G-codes (not HIPPS codes) for the individual dos. I do not use 0023 for the rev code. I use  0551 – snv, 0421 – pt, 0431 – ot

I hope this helps and it works for you.

Kelly Rader

Billing Specialist

Hennepin Home Health Care

763-425-5959  ex 44

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Mary Hanson
Sent: Wednesday, October 27, 2021 4:05 PM
To: billers@list.mnhomecare.org
Subject: Payor MEDM1

Hello!

I know a couple of weeks ago there were some emails about this Medica payor.  We still have some that go back to January that they’ve denied but I have pretty much given up trying to get these to pay.  Every time I talked to someone I was given a different answer on what they were looking for.  We used occurrence code 50 and Rev Code 0023 as previously stated by others.

Well, they have now started taking back claims that we were paid for.  The Reason is CO16 Claim/service lacks information or has submission/billing errors which is needed for adjudication and  N463 which states missing support data for claim.

Has anyone gotten any where on getting these paid?  Or been able to have the take back reconsidered?

Any help is greatly appreciated.

Thanks!

Mary Hanson | Billing Specialist | River Valley Home Care Inc.

916 8th Street Farmington, MN 55024

Phone: 651-460-4201

Email: mhanson@rvhci.com