05-14-24
Good Morning,
Wondering if I can get a question posted on the blog when
you have time please?
My claims are denying from Ucare MH TCM for a client.
The client has BCBS private insurance. Ucare is telling me since the
client has private insurance we have to bill this prior to Ucare paying.
Are other counties having issues with this? Do you bill the TPL? If
not, how do you get Ucare to pay?
Thank you!
Accounting
Specialist
HHS Finance
622 S Front Street
St. Peter, MN 56082
Phone: 507-934-8578
Mission: Providing efficient services with innovation and
accountability.
Core Values:
Integrity. Accountability. Innovation. Leadership.
Efficiency.
Unless I am not reading this correctly, but if they have BCBS private insurance, then you can't bill for MH TCM. They need to have Prepaid Medical Assistance insurance in order to bill for MH TCM. Are you trying to bill UCare because the client has Ucare and BCBS private insurance?
ReplyDeleteHi, the client has Ucare along with BCBS private insurance.
DeleteOur understanding is if they have a private insurance the PPHP will not pay. We don't try to claim from the client as "patient responsibility either".
ReplyDeleteIf a client has a PPHP with a TPL we will claim to the TPL (their Primary) to get the denial and then submit the claim to the PPHP. There are a lot of times that the TPL won't mail you the EOP and you have to check their website for the information to put on the claim to submit it.
ReplyDeleteIf I were you I would try to get a hold of the Claims Supervisor or if you know who your PMAP UCare through the State is contact them to see if they can get you to someone that can help you with this claim. If they have paid for claims in the past they should continue to pay even if the client has Primary Insurance. I just had to do this with a different PMAP insurance and after this reached the Claims Supervisor my claim got paid.
ReplyDeleteYou need to bill the private insurance first. I would call BCBS and find out if its a covered service, and if it is, what they require for you to claim, ie authorization. If its part of their deductible, then you'll bill Ucare as secondary payer for that amt. If its not covered, claim to BCBS to get the denial and rebill to Ucare as a secondary payer. You can let me know if you need help with that.
ReplyDelete