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help billing prenatal care with change of insurance in the middle

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  • Pho
    We bill for prenatal care and postpartum care only (cannot bill 59400 because we don t provide any portion of labor and delivery). Patient had a private
    Message 1 of 4 , Sep 29, 2009
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      We bill for prenatal care and postpartum care only (cannot bill 59400 because we don't provide any portion of labor and delivery).

      Patient had a private insurance plan for the first 26 weeks of pregnancy, and was seen for 7 visits during that time. Billed insurance 59426, with lump sum for the 7 visits. Insurance paid 80%, leaving 20% patient portion.

      Patient then got Tricare with a retroactive effective date, resulting in a one-month overlap of coverage for weeks 22-26 of pregnancy. She was seen for two visits during that time.

      It seems that I should be able to bill Tricare as a secondary for those two visits, but since I'm only billing them for two visits, the 59426 would not apply. If I revert to any other coding, the procedure codes would not match the primary billing.

      Do I go ahead and bill Tricare the 59426 with the original billed amount, since the 7 visits ENDED once she was covered by them?

      Thank you all in advance for your feedback.

      -Phoenicia
    • Linda Walker
      Overlapped policies don t mean you can bill both even primary then secondary, you have to call Tricare because they may not have the correct effective date or
      Message 2 of 4 , Sep 29, 2009
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        Overlapped policies don't mean you can bill both even primary then
        secondary, you have to call Tricare because they may not have the correct
        effective date or may not have known about the primary, The overlapped
        policy is not necessarily a secondary.



        Linda Walker

        Practice Managers Resource & Networking Community
        <http://www.billerswebsite.com> http://www.billerswebsite.com
        A division of K&L Media, LLC
        <http://www.klmediallc.com> http://www.klmediallc.com

        Website Design & Management for the Medical Services Industry



        From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
        On Behalf Of Pho
        Sent: Tuesday, September 29, 2009 3:57 PM
        To: MedicalBillers@yahoogroups.com
        Subject: [MedicalBillers] help billing prenatal care with change of
        insurance in the middle





        We bill for prenatal care and postpartum care only (cannot bill 59400
        because we don't provide any portion of labor and delivery).

        Patient had a private insurance plan for the first 26 weeks of pregnancy,
        and was seen for 7 visits during that time. Billed insurance 59426, with
        lump sum for the 7 visits. Insurance paid 80%, leaving 20% patient portion.

        Patient then got Tricare with a retroactive effective date, resulting in a
        one-month overlap of coverage for weeks 22-26 of pregnancy. She was seen for
        two visits during that time.

        It seems that I should be able to bill Tricare as a secondary for those two
        visits, but since I'm only billing them for two visits, the 59426 would not
        apply. If I revert to any other coding, the procedure codes would not match
        the primary billing.

        Do I go ahead and bill Tricare the 59426 with the original billed amount,
        since the 7 visits ENDED once she was covered by them?

        Thank you all in advance for your feedback.

        -Phoenicia





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        database 4468 (20090929) __________

        The message was checked by ESET Smart Security.

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        [Non-text portions of this message have been removed]
      • Jamie
        Tricare would be secondary if she was still eligible for her private insurance during the same coverage period. Find out her term date with the private. For
        Message 3 of 4 , Sep 29, 2009
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          Tricare would be secondary if she was still eligible for her private insurance during the same coverage period. Find out her term date with the private. For the retroactive period submit the balance to Tricare as secondary up to her term date. The 59426 would still apply to these two visits because you have been billing this to her primary all along. 
           
          Jamie  

          --- On Tue, 9/29/09, Linda Walker <linda@...> wrote:


          From: Linda Walker <linda@...>
          Subject: RE: [MedicalBillers] help billing prenatal care with change of insurance in the middle
          To: MedicalBillers@yahoogroups.com
          Date: Tuesday, September 29, 2009, 4:03 PM


           



          Overlapped policies don't mean you can bill both even primary then
          secondary, you have to call Tricare because they may not have the correct
          effective date or may not have known about the primary, The overlapped
          policy is not necessarily a secondary.

          Linda Walker

          Practice Managers Resource & Networking Community
          <http://www.billersw ebsite.com> http://www.billersw ebsite.com
          A division of K&L Media, LLC
          <http://www.klmedial lc.com> http://www.klmedial lc.com

          Website Design & Management for the Medical Services Industry

          From: MedicalBillers@ yahoogroups. com [mailto:MedicalBillers@ yahoogroups. com]
          On Behalf Of Pho
          Sent: Tuesday, September 29, 2009 3:57 PM
          To: MedicalBillers@ yahoogroups. com
          Subject: [MedicalBillers] help billing prenatal care with change of
          insurance in the middle

          We bill for prenatal care and postpartum care only (cannot bill 59400
          because we don't provide any portion of labor and delivery).

          Patient had a private insurance plan for the first 26 weeks of pregnancy,
          and was seen for 7 visits during that time. Billed insurance 59426, with
          lump sum for the 7 visits. Insurance paid 80%, leaving 20% patient portion.

          Patient then got Tricare with a retroactive effective date, resulting in a
          one-month overlap of coverage for weeks 22-26 of pregnancy. She was seen for
          two visits during that time.

          It seems that I should be able to bill Tricare as a secondary for those two
          visits, but since I'm only billing them for two visits, the 59426 would not
          apply. If I revert to any other coding, the procedure codes would not match
          the primary billing.

          Do I go ahead and bill Tricare the 59426 with the original billed amount,
          since the 7 visits ENDED once she was covered by them?

          Thank you all in advance for your feedback.

          -Phoenicia

          __________ Information from ESET Smart Security, version of virus signature
          database 4468 (20090929) __________

          The message was checked by ESET Smart Security.

          http://www.eset com

          [Non-text portions of this message have been removed]
















          [Non-text portions of this message have been removed]
        • Linda Walker
          In my response I did miss the point the other insurance was private however it still matters what type of plan it was..An overlapped plan still does not mean
          Message 4 of 4 , Sep 30, 2009
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            In my response I did miss the point the other insurance was "private"
            however it still matters what type of plan it was..An overlapped plan still
            does not mean it just becomes secondary, in this case I think they should
            actually call both carriers to let them determine that. If Tricare gets the
            claim as secondary they might not research and put down they have other
            coverage which will create a problem in the future. I would ask the carrier
            if they already have the information on file and a determination of primary
            benefits is in place and for how long (what dates). I had a similar
            situation in which my husband switched plans so during the wait period we
            got a private plan and then when the group plan became effective we had 4
            weeks of overlapping coverage but because the private plan had a clause not
            allowing for overlapping coverage we did get a pro-rated credit on the
            private plan and their term date was set back.



            Linda Walker

            Practice Managers Resource & Networking Community
            <http://www.billerswebsite.com> http://www.billerswebsite.com
            A division of K&L Media, LLC
            <http://www.klmediallc.com> http://www.klmediallc.com

            Website Design & Management for the Medical Services Industry



            From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
            On Behalf Of Jamie
            Sent: Tuesday, September 29, 2009 9:54 PM
            To: MedicalBillers@yahoogroups.com
            Subject: RE: [MedicalBillers] help billing prenatal care with change of
            insurance in the middle





            Tricare would be secondary if she was still eligible for her private
            insurance during the same coverage period. Find out her term date with the
            private. For the retroactive period submit the balance to Tricare as
            secondary up to her term date. The 59426 would still apply to these two
            visits because you have been billing this to her primary all along.

            Jamie

            --- On Tue, 9/29/09, Linda Walker <linda@...
            <mailto:linda%40billerswebsite.com> > wrote:

            From: Linda Walker <linda@...
            <mailto:linda%40billerswebsite.com> >
            Subject: RE: [MedicalBillers] help billing prenatal care with change of
            insurance in the middle
            To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>

            Date: Tuesday, September 29, 2009, 4:03 PM



            Overlapped policies don't mean you can bill both even primary then
            secondary, you have to call Tricare because they may not have the correct
            effective date or may not have known about the primary, The overlapped
            policy is not necessarily a secondary.

            Linda Walker

            Practice Managers Resource & Networking Community
            <http://www.billersw ebsite.com> http://www.billersw ebsite.com
            A division of K&L Media, LLC
            <http://www.klmedial lc.com> http://www.klmedial lc.com

            Website Design & Management for the Medical Services Industry

            From: MedicalBillers@ yahoogroups. com [mailto:MedicalBillers@ yahoogroups.
            com]
            On Behalf Of Pho
            Sent: Tuesday, September 29, 2009 3:57 PM
            To: MedicalBillers@ yahoogroups. com
            Subject: [MedicalBillers] help billing prenatal care with change of
            insurance in the middle

            We bill for prenatal care and postpartum care only (cannot bill 59400
            because we don't provide any portion of labor and delivery).

            Patient had a private insurance plan for the first 26 weeks of pregnancy,
            and was seen for 7 visits during that time. Billed insurance 59426, with
            lump sum for the 7 visits. Insurance paid 80%, leaving 20% patient portion.

            Patient then got Tricare with a retroactive effective date, resulting in a
            one-month overlap of coverage for weeks 22-26 of pregnancy. She was seen for
            two visits during that time.

            It seems that I should be able to bill Tricare as a secondary for those two
            visits, but since I'm only billing them for two visits, the 59426 would not
            apply. If I revert to any other coding, the procedure codes would not match
            the primary billing.

            Do I go ahead and bill Tricare the 59426 with the original billed amount,
            since the 7 visits ENDED once she was covered by them?

            Thank you all in advance for your feedback.

            -Phoenicia

            __________ Information from ESET Smart Security, version of virus signature
            database 4468 (20090929) __________

            The message was checked by ESET Smart Security.

            http://www.eset com

            [Non-text portions of this message have been removed]

            [Non-text portions of this message have been removed]





            __________ Information from ESET Smart Security, version of virus signature
            database 4468 (20090929) __________

            The message was checked by ESET Smart Security.

            http://www.eset.com



            [Non-text portions of this message have been removed]
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