We bill Humana both ways and get paid both ways. Depends on what we get approval for.
Traci Olson
Regency Home HealthCare
651-488-4655 Office
651-488-4656 Fax
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From: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
On Behalf Of Mortenson,Crisa
Sent: Tuesday, October 10, 2023 8:44 AM
To: billers@list.mnhomecare.org
Subject: Re: PDGM contracts - general question
My personal history with humana is that they will tell you it's fee for service, but it's PDGM. I've tried billing both ways on various occasions and they always deny fee for service claims and
I end up having to submit PDGM claims. So, my nurses know that humana is always PDGM for us, no matter what the rep says when they get an auth.
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 Alicia Schmidt <Alicia.Schmidt@knutenelson.org>
Sent: Tuesday, October 10, 2023 8:40 AM
To: billers@list.mnhomecare.org <billers@list.mnhomecare.org>
Subject: [EXTERNAL] PDGM contracts - general question
We are working on updating a few contracts and hoping to get PDGM reimbursement for Medicare plans. When we contacted Humana, they told us that they do not pay PDGM rates, but I was thinking others had mentioned that they got paid that
way. And I might be mistaken on that portion.
Currently the payors that we do not get paid PDGM rates would be United HealthCare, Medica, Humana, Ucare (switching for us 2024) and Health Partners. Does anyone have their contracts with these payors as PDGM versus FFS? We just want
to make sure that what they are telling us is accurate.
Thanks,
Alicia Schmidt
Accounts Receivable Manager
2715 Hwy 29 S Ste 103, Alexandria MN, 56308
Office: 320-759-3340 | Fax: 320-759-1275
knutenelson.org
| Nonprofit Senior Lifestyle Provider
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