I was told the other day that all Home Care claims with TOB 32X need 50 occurrence code and M0090 date(even the MA ones) so I resent those.

 

For UCare Medicare ones I have included 0023(but only one 0023 line-not 2-in past have gotten denied for that. Also have 50 and M0090 on them. Appears like they will be paying. Did NOT send NOA.

 

Karen

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Sent: Wednesday, March 1, 2023 1:48 PM
To: billers@list.mnhomecare.org
Subject: EXTERNALRE: UCare 1.1.23 claims

 

CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe.

 

Ok I have some that denied under that reason but I haven’t called yet. We should Not have to bill MA plans like medicare. ugh

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hanson,April
Sent: Wednesday, March 1, 2023 1:46 PM
To: billers@list.mnhomecare.org
Subject: Re: UCare 1.1.23 claims

 

M79 is the denial reason. Thanks! April Hanson Patient Accounts Perham Living Ph: 218. 347. 1894 F: 218. 347. 1885 April. Hanson@ perhamhealth. org Dedicated to health and wellness throughout life. From: billers@ list. mnhomecare. org <billers@ list. mnhomecare. org>

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M79 is the denial reason. Thanks!

 

April Hanson

Patient Accounts

Perham Living

Ph: 218.347.1894

F: 218.347.1885

April.Hanson@perhamhealth.org

Dedicated to health and wellness throughout life.

 

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Salin, Tracy M - Tracy.Salin at fairview.org (via billers list) <billers@list.mnhomecare.org>
Sent: Wednesday, March 1, 2023 1:35 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: UCare 1.1.23 claims

 

What is your denial reason? My ucare ma claims are paying. My ucare medicare claims are ok. MY project with ucare was from last year….

To my knowledge they are to be billed just like medicare so you should have all value codes attached and hipps code service line.

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hanson,April
Sent: Wednesday, March 1, 2023 1:32 PM
To: billers@list.mnhomecare.org
Subject: Re: UCare 1.1.23 claims

 

Tracy- I am wondering if you had any luck with your Ucare project? I have denials for Ucare January claims as well for not having occurrence code 50 on the claim. Is it just the occurrence code they are looking for or should these all be billed

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Tracy- I am wondering if you had any luck with your Ucare project? I have denials for Ucare January claims as well for not having occurrence code 50 on the claim. 

 

Is it just the occurrence code they are looking for or should these all be billed completely following CMS requirements? 

 

Thanks!

 

April Hanson

Patient Accounts

Perham Living

Ph: 218.347.1894

F: 218.347.1885

April.Hanson@perhamhealth.org

Dedicated to health and wellness throughout life.

 

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Salin, Tracy M - Tracy.Salin at fairview.org (via billers list) <billers@list.mnhomecare.org>
Sent: Wednesday, February 15, 2023 12:57 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: UCare 1.1.23 claims

 

Its not an authorization issue. It’s a claims processing issue. My MA plans had 5 denials with M79 and 1 Medicare plan with M79. I called and explained to rep. She recommended I open a project as it affects more than 3 claims. I will be doing this. I of course am anticipating more denials as all my Jan claims haven’t processed yet… Funtimes!!!!! The occurrence code 50 points to oasis assessment/reassessment date for PDGM processing so insurance knows which one to look at for the HIPPS code so they can pay appropriately under pdgm rules. Ma plans are not PDGM.

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of VIG,TERISA
Sent: Wednesday, February 15, 2023 12:52 PM
To: billers@list.mnhomecare.org
Subject: Re: UCare 1.1.23 claims

 

I don’t know if this is just my issue but 5 clients switched to ucare Jan 1 and ucare did not set them up with Medicaid just Medicare connect so all of their claims denied with m79. I have our county workers looking into it for me. Those on

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I don’t know if this is just my issue but 5 clients switched to ucare Jan 1 and ucare did not set them up with Medicaid just Medicare connect so all of their claims denied with m79. I have our county workers looking into it for me. Those on ucare prior to Jan 1 paid fine. 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Mary Hanson <mhanson@rvhci.com>
Sent: Wednesday, February 15, 2023 12:38:25 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] UCare 1.1.23 claims

 

Hello All,

 

Finally received a remittance today with many January claims that had been unprocessed.  Some of these had shown in their system as pending with an amount of payment but unfortunately many claims denied.  Reason Code M79 – Missing/incomplete/invalid charge.

 

I did talk to provider services today.   Here is what I was told:

 

“Refer to the provider bulletin which reference CMS billing guidelines.  Missing Occurrence Code 50 with bill type 032X.”

 

My question to the group is what is everyone doing when they bill these claims with the plans they list in the bulletin which I have attached?  Are they wanting PPS billing?  Are you sending NOA’s?

 

One plan involved is UCare Connect + Medicare.  So, even though these are Medicaid claims they are processing them as Medicare?  I’m sorry but I am confused.

 

Any help on what you are doing that is working is greatly appreciated!!

 

Thank you.

 

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

916 8th Street Farmington, MN 55024

Phone: 651-460-4201

Email: mhanson@rvhci.com

 

 

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