Recent Posts

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Billing / Re: Texas BCBS Medicaid and DME
« Last post by Sriram_Sub on January 11, 2018, 07:41:10 AM »
Please try accessing the provider manual from the URL below. The Index pages of these manuals have a section for "Benefit Codes" each. You can choose the appropriate one from the list and work with your billing software vendor and EDI Clearinghouse to have Box 11 of CMS1500 to report the correct Benefit code.

Hope this helps.
Billing / Re: Patient did not disclose that they had insurance
« Last post by Sriram_Sub on January 11, 2018, 07:26:10 AM »
If you have a patient registration form that did not state any insurance info disclosed by the patient, that document along with the receipt for full payment made by patient stand as a proof that there was no insurance fraud committed by you.

Aetna's Timely filing limit (as you may be knowing) is 90 days. If there is still time, please confirm eligibility and try submitting it to the payer. Upon receipt of payment from Aetna, you may decide on refunding to the patient. If the TFL is already lost, the patient has no right to claim it from your office.
New! / Re: Medicare - CO151 - Payment adjusted because the payer deems the information
« Last post by rhina on January 10, 2018, 12:36:24 PM »
I got same denial from Medicare 151 :  Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Cpt J7322--units-96
Billing / Patient did not disclose that they had insurance
« Last post by PsychBiller on January 10, 2018, 09:49:26 AM »

Happy New Year to everyone!

A patient of ours did not disclose that they had Aetna insurance, paid the full amount for services, and then filed their own claims with insurance.  Months later they produced their insurance information and asked for us to submit claims going forward.

Now they are demanding that they be reimbursed for those visits where they paid the full price (basically wanting the difference between what was allowed by insurance and what they paid), and are claiming that we have committed insurance fraud.

Do I need to reimburse them?
Billing / Re: Texas BCBS Medicaid and DME
« Last post by Michele on January 10, 2018, 09:41:23 AM »
I'm sorry but that is a very specific question for an issue that we have not experienced.  I personally would call the rep back and tell them you haven't heard yet. 
Billing / Texas BCBS Medicaid and DME
« Last post by mandaree23 on January 10, 2018, 09:15:07 AM »
Happy New Year!  I am hoping someone can help me with some Medicaid challenges.  I bill orthotics and prosthetics in Texas.  I have several denials from our Texas BCBS Medicaid products stating to resubmit with Correct Benefit Code.  I know the Correct Benefit Codes vary depending on whether it's STAR vs STAR KIDS, if it's paper vs electronic and depending on the programs we are contracted with.

I have called the carrier and the rep was unable to answer and sent a message to their help-desk and I've yet to hear back.  Is there anyone that is familiar with this that can explain or point me in direction to find online. 

Thank you!!!
New! / Re: Questions about Provider's asking for your tax id?
« Last post by PMRNC on January 09, 2018, 10:30:05 AM »
Actually I would wonder why they wouldn't ask for it or your invoices wouldn't have it on there. Mine do. A business should always include Tax ID number on their invoices. This is why it's good idea to get a Tax ID even if you don't have employees or your a sole propietor. Even if he only paid $323 he might still have enough to itemize with other deductions. For $323 you don't have to do a 1099 so that's probably why he needs your Tax ID.
New! / Questions about Provider's asking for your tax id?
« Last post by Jmojica on January 08, 2018, 01:31:06 PM »
Happy New Year everyone!

I have been running my business for 2yrs now and this week is the first week a provider asked me for my tax id. So this is new to me. This provider only paid $323 for the entire year of 2017, is this common?
General Questions / Re: Qualifications of a Medical Biller
« Last post by PMRNC on January 08, 2018, 09:32:59 AM »
Tallmanusa,  Linda was responding to a post that the poster since deleted.  Apparently it was after our responses.

YES.. at first I thought I was seeing things but the newer post is gone. That is absolutely annoying.  :-\ ::) >:( :o
Billing / Re: Help!!How do I complete claim for Medicare Denial EOB ???
« Last post by PMRNC on January 08, 2018, 09:31:40 AM »
Michele is right, you cannot bill medicare unless you are enrolled and since they will not allow LPC's to be enrolled you won't be able to get a denial. Some states as mentioned DO know that LPC's cannot enroll and SOME Medicaid plans will pick up but that's not a guarantee. Best to call your Medicaid office and find out. You'll of course also have to be enrolled in your state Medicaid plan for them to even consider the bill. I'd call Medicaid to find out how and if this can be done. Sometimes you can attach a letter to your claim for the secondary payer and site the specific code (Section 1861(s)(2) of the Social Security Act) which excludes LMFTs and LPCs as Medicare providers. I'm not sure this will help and you may have to write off the balance and discuss with the patient for future visits.
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