I started sending my UCare Medicare claims with a NOA and PDGM back in December I think.   I have had 2 pay and 4 are still pending.

 

Marnie

 

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Mary Hanson
Sent: Wednesday, March 01, 2023 1:45 PM
To: billers@list.mnhomecare.org
Subject: RE: UCare 1.1.23 claims

 

**External Sender**

 

I think we are finally getting on track with our ma claims by adding occurrence code 50 but we are struggling with the Medicare claims.  They were paying but now they are denying.  The reason is the same as the ma Reason M79.  We have never billed UCare Medicare as PDGM.  Does anyone know if all they really want on the Medicare claims is the occurrence code 50?  Or do they want PDGM with NOA, etc?

 

Thanks!

 

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: Wednesday, March 1, 2023 1:35 PM
To: billers@list.mnhomecare.org
Subject: 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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