Billing > Billing
Capitation Accounts
Michele:
Connex is the online system to look up Medicare beneficiaries and claims data.
kayfly:
I looked it up and it is not available for Idaho! Thank you though, I have a call in to Medicare...on hold now!
kristin:
Each MAC has their own system/application for looking up what insurance a patient has. Mine is Connex, but other places I work for use Novitasphere, FCSO, etc,. You need to get set up with the portal for your particular MAC.
It seems that while the patient(s) is saying they have standard Medicare, they may actually be enrolled in a Medicare Advantage plan. This is not uncommon. You can also use Availity to find out if they have an MA plan instead of standard Medicare.
kayfly:
Thank you Kristin, I hate Availity but I will try it! These capitation issues throw me for a loop
kristin:
Availity is great for certain things, and this is one of them. Other things, not so much.
Generally speaking, whenever you see a denial for a Medicare patient stating it is a capitation issue, that means they have a Medicare Advantage plan which needs to be billed instead.
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