Medical Billing Forum

Billing => Billing => Topic started by: Christy on January 09, 2015, 11:35:49 AM

Title: TriCare/ NYS Medicaid for LCSW?
Post by: Christy on January 09, 2015, 11:35:49 AM
Hi all,

Perhaps someone can help?  I verified benefits for a Tricare member and was told that everything is active, good to go, etc..... Then all of our (LCSW) claims were denied due to non-active service member/not eligible. UGH!

AND FYI, I verified benefits while the patient was in the midst of treatment (I was hired by LCSW at that time), so it's not like it was active when I called, then suddenly terminated.

The patient is getting a 3 month retroactive Medicaid to cover her bills (had a baby!) that were denied by Tricare.

BUT, would NYS Medicaid pay for the denied services provided by an LCSW? Medicaid usually only covers LCSWs if the patient has Medicare primary and NYS Medicaid 2ndry.....

any guidance appreciated!

thanks!
Title: Re: TriCare/ NYS Medicaid for LCSW?
Post by: PMRNC on January 09, 2015, 04:58:17 PM
Perhaps someone can help?  I verified benefits for a Tricare member and was told that everything is active, good to go, etc..... Then all of our (LCSW) claims were
Quote
denied due to non-active service member/not eligible. UGH!

AND FYI, I verified benefits while the patient was in the midst of treatment (I was hired by LCSW at that time), so it's not like it was active when I called, then suddenly terminated.

The patient is getting a 3 month retroactive Medicaid to cover her bills (had a baby!) that were denied by Tricare.

BUT, would NYS Medicaid pay for the denied services provided by an LCSW? Medicaid usually only covers LCSWs if the patient has Medicare primary and NYS Medicaid 2ndry.....

any guidance appreciated!

OUCH .. sticky... Remember that verification of benefits is never a guarantee of payment.   But to answer.. if Medicaid will not cover, you may be  S.O.L.   

Title: Re: TriCare/ NYS Medicaid for LCSW?
Post by: Billing2 on January 29, 2015, 11:50:20 AM
Did you get a copy of the front and back of there TRICARE card?

Do you print out the from the TRICARE website that showed active at the time of services?

What was the members status at the time, by that I mean active duty or guard?

Sorry so many questions, but a way to help you.
Title: Re: TriCare/ NYS Medicaid for LCSW?
Post by: PMRNC on January 30, 2015, 05:24:15 PM
ďA quote of benefits and/or authorization does not guarantee payment or verify
eligibility. Payment of benefits are subject to all terms, conditions, limitations,
and exclusions of the memberís contract at time of service.Ē

Title: Re: TriCare/ NYS Medicaid for LCSW?
Post by: Christy on February 01, 2015, 12:36:18 PM
thanks, ladies!  :)