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Treatment Authorization code for home health

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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?

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