Treatment Authorization code for home health

[Catresej]

Hi,

Can anyone please tell me an easy way to create or get the treatment authorization code to bill for home health care because the insurance has denied the claim over not having it.  I heard it has 18 characters and we are an out of network provider.

Thank you, kindly

[Michele]

I believe you are looking for a treatment authorization number?  It sounds like the patient's plan doesn't allow out of network benefits.  A treatment authorization number would be obtained prior to treatment by an in network provider.

[Giver100]

Thank you for responding.  Yes, we are out of network but the client insisted to use us.  So, after weeks of disputing the insurance approved the services and they gave us an authorization number but I guess it's not the same number?  The insurance is Humana medicare.  How can I go about getting this because they sent us approval and said they will pay us and act as if it's no problem the whole time.  Can you please tell me what we should do? As I said, I have an authorization number that isn't 18 characters long. They mentioned looking at the OASIS manual to figure it out.

Thank you, kindly

[Michele]

I have not heard of this before and honestly I thought you were getting a run around, but then I read this:  http://kb.barnestorm.biz/KnowledgebaseArticle50551.aspx 

It shows that the treatment authorization code does come from OASIS.  I'm hoping that link will help you find out how to get the number.

[Giver100]

It is not a skilled nursing case so can Humana have the rights to not pay us without the treatment authorization code?  The service code is G2099 that was given as well as diagnostic R68.89.

[Michele]

Since you are out of network it is really the patient's issue to appeal.  Not that you want to push it onto them, but they may have better luck.  Are they in a position to call Humana and ask what they need you to do?  I know you have already tried, but they may have better luck.  It seems to me if they authorized the treatment even though it is out of network, they should be honoring that.  However, authorization is not a guarantee of benefits.  So again, it kind of falls back on the patient since they knew you were out of network. 

I wish I had a better answer, but they are telling you to put a treatment authorization code on the claim that they aren't providing. 

[hhabiller11]

Hi Catresej,
I'm assuming this is for a home health claim? Treatment Authorization Codes (TAC) are different from visit authorization codes. TAC comes from the OASIS. So your software should automatically generate this for you. The reason why you may not be generating them could be from the way you're insurance is set up. Make sure the option to treat the insurance as Medicare/Medicare Advantage claim is selected. It may just be a software issue so maybe call them so they can assist you on how to set up the insurance properly. Also keep in mind for 2020 episode start dates, TAC are no longer required on PDGM claims. I hope that helps!

[Michele]

Thanks hhabiller11!  I have not ever had to deal with TACs and wasn't sure how to help. 

[Giver100]

Yes, thank you BOTH so much!  The information was extremely helpful for me to get down to the bottom of it.  Thanks again:)

[Giver100]

Hi,

Can you please tell me if the 2020 PDGM claim guidelines will benefit private duty, non-medicare certified agencies?

[Michele]

I am not educated on HH billing but from what I read about PDGM it refers mainly to Medicare certified HHAs.  I'm not sure if it will benefit non medicare certified agencies.  That doesn't mean that it won't, I just am not finding any information indicating it will.

[Giver100]

Thank you!