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Re: MEDICARE DENIAL

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  • Melinda
    This has to do with Coordination of Benefits (COB). This is because at some point there was an MVA, or home accident, other third-party liability. The patient
    Message 1 of 4 , Oct 21, 2011
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      This has to do with Coordination of Benefits (COB). This is because at some point there was an MVA, or home accident, other third-party liability. The patient never called COB and let them know that Medicare was no longer the Medicare Secondary Payer (MSP). This will need to be done. Most likely the patient will need to call, but you can call and see what info. they have on file so you know what to have the patient call & correct.

      Hope that helps!

      Melinda Brown, CMBS
      Ins Biller

      --- In MedicalBillers@yahoogroups.com, josette sylvan <abcmdbiller123_55@...> wrote:
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      > that info is incorrect. no fault auto issue
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      > how ever the problem is that the patient had a nf case at some point, it is stuck in limbo, per mc that is what it is, to fix it there is a special department to call, I am at work when I get home I will try to send the info
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      > > To: MedicalBillers@yahoogroups.com
      > > From: muhl4groups@...
      > > Date: Wed, 19 Oct 2011 18:49:49 +0000
      > > Subject: Re: [MedicalBillers] MEDICARE DENIAL
      > >
      > > This typically means the pt has a medicare hmo and not reg medicare if u get their correct card with hmo info u would just bill to the proper hmo the other is a coordination of benefits issue medicare thinks the pt is covered primary with a injury insurance like an accident or work comp company. Pt needs to coordinate benefits with medicare and then u should be able to refile this. Feel free to email me for more specific information on these. Muhl4groups@...
      > >
      > > Sent from my Verizon Wireless BlackBerry
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      > >
      > >
      > > -----Original Message-----
      > >
      > > From: Halbert <halberts1@...>
      > >
      > > Sender: MedicalBillers@yahoogroups.com
      > >
      > > Date: Wed, 19 Oct 2011 11:38:39
      > >
      > > To: medical billers<MedicalBillers@yahoogroups.com>
      > >
      > > Reply-To: MedicalBillers@yahoogroups.com
      > >
      > > Subject: [MedicalBillers] MEDICARE DENIAL
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      > >
      > >
      > > I'm having a problem getting regular visits paid from Medicare. Example: 99213 Dx: 401.1 272.4 244.9. The remark is 24 Charges are covered under a capitation agreement/managed cared plan.
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      > > Is there any way to get paid for these? We see alot of Medicare patients for their regular maintenance visits.....
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      > > Thanks
      > >
      > > Christy
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      > > ------------------------------------
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      > > Yahoo! Groups Links
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