Funny you say that, our facility has not had a good experience with the set up of PCC either, they have been very disappointed in that aspect. But once they are up and running in it, it will be much better than what our SNF and AL were currently using.

I hope you have a great weekend April! 😊

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hanson,April
Sent: Friday, March 17, 2023 2:13 PM
To: billers@list.mnhomecare.org
Subject: Re: MA secondary to Humana

**External Sender**

We use PCC for our catered living and memory care programs. We had a bad experience with the set up but it's improved a lot since then. The programs we use it for are so different than many of the other types of programs it is used for. I have heard many good things about it from our SNF staff.

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 Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Friday, March 17, 2023 2:06 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: MA secondary to Humana

We are not sure yet. Our SNF and AL are switching to PCC, they were hoping we could get that for home care and hospice. Unfortunately, PCC does not have a hospice package, so we have a couple more platforms to look at. I am going to miss Epic.

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hanson,April
Sent: Friday, March 17, 2023 2:03 PM
To: billers@list.mnhomecare.org
Subject: Re: MA secondary to Humana

**External Sender**

Marnie,

Oh my gosh which system are you moving to??

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 Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Friday, March 17, 2023 1:57 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: MA secondary to Humana

April,

I know what you are saying, and you are correct, it is not possible because the billing requirements are so different.

FYI – I am not sure I told you this or not, our facility is changing to a different Epic this summer, when they do that, Home Care and Hospice will not get to change over to the new Epic because it is so costly. So we will be going to a different program. I am so sad. We know as far as programs go, our home care and hospice will be going backwards a bit. ☹

Marnie

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hanson,April
Sent: Friday, March 17, 2023 1:51 PM
To: billers@list.mnhomecare.org
Subject: Re: MA secondary to Humana

**External Sender**

Marnie,

Do you do anything in Epic as far as having a copy of the claim in epic? Our facility always wants to have a claim in Epic like what was submitted to each insurance. But in this case, I don't know how we could possibly have a claim in Epic since the billing requirements are so different for these payers and you can't really bill the secondary claim in Epic. 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 Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Friday, March 17, 2023 1:46 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: MA secondary to Humana

Correct, no auth required for PT and OT. MA might not pay anything if Humana paid more than the MA allowable. But you will have an official remit from MA then.

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hanson,April
Sent: Friday, March 17, 2023 1:38 PM
To: billers@list.mnhomecare.org
Subject: Re: MA secondary to Humana

**External Sender**

Oh boy. We might run into issues with the SN visits. I know they can have 9 without auth but I don't know how many they used. PT and OT don't require auth for MA correct? 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 Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Thursday, March 16, 2023 10:34 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: MA secondary to Humana

Do you need an authorization from MA for any of the visits?

You will need to manually bill the claim to MA using their billing rules, billing the dates of service by month and do your best to break out the Humana payment per each visit that you need to bill to MA as the secondary pay source.

Marnie

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Hanson,April
Sent: Thursday, March 16, 2023 9:58 AM
To: billers@list.mnhomecare.org
Subject: MA secondary to Humana

**External Sender**

Good morning,

I have a patient who has Humana primary and MA secondary. I am needing to bill a claim to MA secondary as the patient had patient responsibility. I tried to do so and the claim denied for Dates of service and other errors. The issue is that MA requires you to bill FFS and Humana follows Medicare billing guidelines. How can I bill MA secondary when Humana and MA have totally different billing requirements? I work in Epic. Any guidance would be very helpful. This is a new scenario I have never had to deal with before. 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.

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