I have also found a lot of my MSHO final claims have been denied and when I look on availity, it tells me they've denied because a RAP wasn't submitted when the remit says something else, so I've had to appeal A LOT of MSHO final claims lately on availity and in the appeal, I always put a copy the web link of the bulletin that shows that NOAs were to be submitted after July 1, 2022. I wish they would get their processing straight because it's been happening to me for quite a few months now.

Crisa Mortenson

Billing Officer

Phone: 218-843-3852

Fax : 218-843-2311

Email: crisa.mortenson@kmhc.net

1010 S Birch Ave. P.O. Box 700

Hallock, MN 56728

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> on behalf of Marnie Pogreba <marniepogreba@lakewoodhealthsystem.com>
Sent: Friday, June 23, 2023 2:41 PM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] RE: Medicare question

I would also look up the claim in Availity. It seems like some of my Remits have said that, and when I look the claim up in Availity it said something else. I have had some say the authorization was missing or that the claim denied as a duplicate. In which case they really processed the claim wrong, because we had auth from Evicore and the Claim is not a duplicate to the NOA.

Marnie

From: billers@list.mnhomecare.org <billers@list.mnhomecare.org> On Behalf Of Sara Sundberg
Sent: Friday, June 23, 2023 2:33 PM
To: billers@list.mnhomecare.org
Subject: Re: Medicare question

**External Sender**

I had this happen on one of my MSHO/MC claims. I waited a little bit and resent it. It did process and pay the second time. I had also sent an NOA as well. I don't know if information crossed the first time, or if it is a bogus denial. It was the first time I had seen it though.

Sara

On Fri, Jun 23, 2023 at 2:22 PM Mary Hanson <mhanson@rvhci.com> wrote:

Hello Friends,

I had an invoice for BCBS Medicare Advantage plan deny for reason “This service/procedure requires that a qualifying service/procedure be received and covered”. “Adjusted because the related hospital charges have not been received”. So, I am interpreting this to mean they won’t process my claim until they receive and process the hospital claim? This is a PPS episode and I did send the NOA. Do I wait and rebill? Or what is my next step?

Thanks for any help you can provide!

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

916 8th Street Farmington, MN 55024

Phone: 651-460-4201

Email: mhanson@rvhci.com

Sara Sundberg

CFO

Good Neighbor Home Health Care

218-829-9238

www.gnhomecare.com

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