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Billing Maryland Medicare if not a Medicare Provider

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barb2512:
Mental Health visits for elderly client were processing correctly up till October of 2012. We were billing a non-Medicare provider and Medicare was processing the claims and then sending them to CareFirst BCBS for processing and payment.

In October of 2012 Medicare switched to using Novitas Solutions as the processor for claims. We are not registered in Novitas system because we are not a medicare provider. Novitas is just kicking out the claims and not processing them and transfering them to BCBS for payment.

I have spoken with Medicare, Novitas and CareFirst and can not find anyone who can tell me why they processed fine up till October 21st and now will not process.

Any help or insights will be greatly appreciated.
Barbara

Michele:
When you say "non-medicare provider" do you mean non par?  I'm a little confused. 

barb2512:
I am not sure. This is all new territory to me. He does not have a medicare provider ID number. He is not in the medicare system so our claims are denied. He is a master's level provider which in the state of Maryland is not allowed to be a medicare provider.

Any help at all is appreciated.

Barbara

Michele:
If he is not a Medicare provider either Par or Non Par he cannot bill Medicare, even for a denial.  If he is a provider who is not accepted by Medicare due to his credentials, but is allowed by other insurance carriers, the other carriers are billed.  Many times a blanket denial letter is required to remind the insurance carrier that even though the patient has Medicare prime, Medicare EOB is not attached because provider is not allowed by Medicare.

barb2512:
Thank you so much. That is what I am doing, sending a letter explaining our situation and that a denied eob is not possible to obtain.

Barb

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