General Category > General Questions

Facility Medicaid Billing

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PMRNC:
For a State Plan Medicaid HMO you would contact your state dept of insurance.


--- Quote ---Most of our HMOs follow TMHP guidelines. The specific plan we are having issues with is kind of tricky. Some instances they say to refer to the TMHP provider manual but for anything else they inform us they have their own guidelines.

--- End quote ---

That's correct, they MAY follow TMHP guidelines, but they don't have to and they will have their own policies as they could. What I would do is when a patient comes in with a Medicaid HMO that you are participating with is first pull the contract. If you are NON par, that's a different story because of course if you are non par with the HMO you won't get paid at all regardless if you are participating with your state's Medicaid plan.


--- Quote ---Even though it's a Medicaid HMO it is funded by the state

--- End quote ---

Not funded, but overseen by the state dept. The HMO still does not have to follow Medicaid but they do have to follow their own policy plan and carrier provisions.


When you contact the state dept, make sure that you have all documentation ready. For them to help you you must have documented each phone call, who you spoke with, what you were told, MOST state dept's now have online filing guidelines as well. Here's what I found for Texas: http://www.tdi.texas.gov/hprovider/providercompl.html

crystallibby:
The problem you are facing is not unique. Sometimes, the medical billing service that you rely upon. Did you check with the company what do they say about this situation? Also, try searching other forums to see if other customers are facing the same situation. If that is true, then you need to consider changing your medical billing service company.

mariorodriguez36:
@crystallibby- I do the Medicaid billing for our facility. We do not use a medical billing service. We have found the source of our issues with this HMO Medicaid plan. Hopefully we see a resolution soon and are able to start the clean up (even though it wasn't our mistakes)

aoptraininginstitute:
Sorry but we haven't had these issues.

BikhamHCare:
Please concern to medical coding agencies.It will suggest all types of solutions.. thanks

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