Recent Posts

Pages: [1] 2 3 ... 10
1
Billing / Re: Medicare as Secondary
« Last post by Darlene on Today at 01:43:50 PM »
They have BCBS primary and then Medicare as secondary.
2
Billing / Re: Medicare as Secondary
« Last post by PMRNC on Today at 01:35:27 PM »
Quote
It is a HSA plan so it all goes to patient deductible and then the patient is to pay with their HSA account.

Forgive me but I'm still completely lost on this.. IF this is a true HSA account, there are no deducibles or out of pocket. An HSA is a Health savings account it is NOT an insurance policy. I'm completely stumped on why an HSA would be PRIMARY to medicare.

Are you saying the patient has BCBS primary ...THEN they have an HSA and then Medicare? If so then the HSA is the payor of last resort because they are the Health savings acct.. NOT an insurance policy.

3
Billing / Re: Medicaid Secondary
« Last post by PMRNC on Today at 01:32:51 PM »
I have run across situations where in NY Medicaid will want us to change codes, however once I contact them, advise them the primary paid according to proper CPT guidelines, this usually prompts them to reconsider the claim. They should NOT be asking for you to change codes for purpose of secondary billing.

4
New! / Re: Secondary insurance billing
« Last post by PMRNC on Today at 01:31:00 PM »
I'm actually having this battle with my OWN health insurance company Administrator (Pomco) IT is NOT common to not have the CPT codes and I've been fighting with my own insurance company for a while and even have a complaint in with the dept of labor because it's an ERISA plan. Our EOB's will have "medical services" or "surgery" or "laboratory services" rather than the darn CPT code. It's Extremely frustrating and in all my years of doing billing and working for insurance companies.. this is the ONLY carrier I've encountered this with. Ironic it's my own.

Quote
the secondary insurance asks for medical records etc to determine medical necessity.
No, I don't think THIS is uncommon, I do ped's and we have some plans with different COB models so we have been asked for records from the secondary when the primary didn't require them.

Quote
Is it true that the primary plans determine medical necessity AND determines the allowed fees?  The secondary insurance then pays a portion of the %

No, I would not say that is common, each carrier might have their own criteria for determining medical necessity but it's not the "normal" to have the secondary decide.. if the primary allows, most secondary's allow, it really depends on the service. I've seen primary carriers deny genetic counseling for example and the secondary want medical necessity. It depends on the plans allowance and what their benefit plan states. If you come across a lot of these I would say your mostly dealing with ERISA plans and in those cases you want to ask the patient for a copy of their summary plan benefit. With ERISA, the patient MUST be involved with all appeals. MOST group plans are ERISA unless they are church/govt plans.


5
New! / Re: Secondary insurance billing
« Last post by Michele on Today at 12:57:24 PM »
Is it true that the primary plans determine medical necessity AND determines the allowed fees?  The secondary insurance then pays a portion of the %.

No.  Each plan will apply their own rules.  Some may say that since the primary determined medical necessity they do not need to, but that is not a rule.  The secondary insurance will process the claim based on their rules.  They don't all necessary pay a portion. 


Also, we have a few primary insurance companies that don't put CPT codes on the Explanation of Benefits, only a general description IE instead of CPT 37722, it will state Surgery. The secondary insurance won't pay unless there is a CPT code. Very frustrating!

That is not common.  Is it a small carrier?  The EOBs that go to patients will have that, but usually the provider copy has the CPT.  I would contact the carrier to see if they have any options.


6
Billing / Re: Medicaid Secondary
« Last post by Michele on Today at 12:53:10 PM »
You would need to change the code when billing Medicaid to one of the codes per your contract.  (The code must match the service obviously.  Just wanted to make sure I mentioned that you should never change a code strictly to get something paid, but we have seen situations where one code is used with one insurance carrier and a different code is used with another for the exact same service.)

You should contact Medicaid.  Most secondaries do not require auth when they are secondary and the primary is paying.  However, you should find out for sure.  If it is a service that Medicaid usually requires auth for then you may have to obtain auth.
7
New! / Secondary insurance billing
« Last post by Nancyo2 on Today at 12:13:26 PM »
We have patients that have primary and secondary insurance companies- we send EOB with claim to secondary however, the secondary insurance asks for medical records etc to determine medical necessity.  Is it true that the primary plans determine medical necessity AND determines the allowed fees?  The secondary insurance then pays a portion of the %. Also, we have a few primary insurance companies that don't put CPT codes on the Explanation of Benefits, only a general description IE instead of CPT 37722, it will state Surgery. The secondary insurance won't pay unless there is a CPT code. Very frustrating!
8
Billing / Medicaid Secondary
« Last post by ABABiller on Today at 10:29:07 AM »
Hello all,

We are an ABA company and each insurance company has different codes for services. I have this case where United is primary and Medicaid is secondary. As I mention the codes that we are contracted to bill for services with each insurance do not match.

So my question is: Before submitting claim to Medicaid, do i need to change the billing codes to match our contract? Or since Medicaid is secondary will they cover regardless of the codes since primary already reimbursed? Also do i need to request authorization thru Medicaid as well?

I tried contacting Medicaid for answers but they just gave me the run around.

Thank you for all your help!!!  ;)
9
Billing / Re: Medicare as Secondary
« Last post by Darlene on Today at 09:59:03 AM »
Ok, thank you for assisting me with this question.

Darlene
10
General Questions / Re: Claim is denied for CO-16
« Last post by Michele on Today at 09:56:06 AM »
I would call back.  You must have gotten a bum rep.  They have all of the information in front of them.  They may tell you that you have to refer to the EOB but you just need to say that you are looking at the EOB but you need clarification.

Pages: [1] 2 3 ... 10