Medical Billing Forum
Billing => Billing => : Christy January 09, 2015, 02:35:49 PM
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Hi all,
Perhaps someone can help? I verified benefits for a Tricare member and was told that everything is active, good to go, etc..... Then all of our (LCSW) claims were denied due to non-active service member/not eligible. UGH!
AND FYI, I verified benefits while the patient was in the midst of treatment (I was hired by LCSW at that time), so it's not like it was active when I called, then suddenly terminated.
The patient is getting a 3 month retroactive Medicaid to cover her bills (had a baby!) that were denied by Tricare.
BUT, would NYS Medicaid pay for the denied services provided by an LCSW? Medicaid usually only covers LCSWs if the patient has Medicare primary and NYS Medicaid 2ndry.....
any guidance appreciated!
thanks!
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Perhaps someone can help? I verified benefits for a Tricare member and was told that everything is active, good to go, etc..... Then all of our (LCSW) claims were
denied due to non-active service member/not eligible. UGH!
AND FYI, I verified benefits while the patient was in the midst of treatment (I was hired by LCSW at that time), so it's not like it was active when I called, then suddenly terminated.
The patient is getting a 3 month retroactive Medicaid to cover her bills (had a baby!) that were denied by Tricare.
BUT, would NYS Medicaid pay for the denied services provided by an LCSW? Medicaid usually only covers LCSWs if the patient has Medicare primary and NYS Medicaid 2ndry.....
any guidance appreciated!
OUCH .. sticky... Remember that verification of benefits is never a guarantee of payment. But to answer.. if Medicaid will not cover, you may be S.O.L.
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Did you get a copy of the front and back of there TRICARE card?
Do you print out the from the TRICARE website that showed active at the time of services?
What was the members status at the time, by that I mean active duty or guard?
Sorry so many questions, but a way to help you.
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“A quote of benefits and/or authorization does not guarantee payment or verify
eligibility. Payment of benefits are subject to all terms, conditions, limitations,
and exclusions of the member’s contract at time of service.”
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thanks, ladies! :)