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RE: [MedicalBillers] help billing prenatal care with change of insurance in the middle

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  • 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 1 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

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