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Who pays

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Tsaav:
Hi everyone.

I have an issue with a claim. The insurance company, United Healthcare, want me to refund back a claim. The claim is for T1019 personal care, which should be paid for by Medicaid. And one of their rep said it should be paid. Told me to let them know when they denied a claim to look in their handbook. The patient does have medicare, but the rep said medicaid pays for personal care. Is this the correct information? I tried to look for their policy online but haven't found where it is.

Thanks,

Tsaav

Pay_My_Claims:
if non-covered by Medicare, and from what I know that isn't you can bill medicaid directly

Michele:
I do not believe that is covered by Medicare.  If Medicaid does cover it they should be billed directly.

Michele

Tsaav:
Well, the issue is that this is a non-skilled long term care with PA. UHC is the HMO of choice for the patient for their medicaid coverage. UHC should be paying, correct?

Pay_My_Claims:

--- Quote from: Tsaav on February 09, 2010, 05:52:15 PM ---Well, the issue is that this is a non-skilled long term care with PA. UHC is the HMO of choice for the patient for their medicaid coverage. UHC should be paying, correct?

--- End quote ---

medicare hmo's follow the same guidelines as medicare. most of them do not cover what Medicare will not.

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