Medical Billing Forum

Billing => Billing => Topic started by: Cpatel on May 16, 2016, 01:52:15 PM

Title: MCO vs BHV
Post by: Cpatel on May 16, 2016, 01:52:15 PM
I need help. My doctor saw patient in the hospital for late syphilis, latent. MCO has denied claim for auth. I called payer who said they never received the facility claim. Then I called facility and rep said because patient was admitted due to psych issues, facility has billed to Bhv plan of the state. I know that Physician will not get paid by Bhv payer. Do I have any chances to get paid after appeal with MCO?

Title: Re: MCO vs BHV
Post by: Michele on May 17, 2016, 12:47:30 PM
I would appeal stating that the facility was reimbursed but by the BHV plan, not the MCO.  You may need proof of some sort.  Start by calling the payer and explaining that the facility was paid by the BHV and see if they can advise anything further.
Title: Re: MCO vs BHV
Post by: PMRNC on May 21, 2016, 01:26:29 PM
If this is an ERISA plan I would also get the patient involved and appeal that way. Much more effective.