How do you handle two ER visits within 24 hours? We have a payer that will pay one claim and the other they global our charges. The TMHP manual states "If a client visits theEmergency Room more than once in one day, the times must be given for each visit.". We've informed the payer that we do this and they still global our claims.
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.
Even though it's a Medicaid HMO it is funded by the state