Medicare Demonstration/Payment

Denials


Increase in denials recently? (March 2014)

Please be sure to check the following if you have received a denials.

  • Is the claim missing demo “58”?

  • Provider may not certified, or MDH may not have received provider Medicare Numbers.

  • Is this a Duplicate bill?

  • Was it filed according to the time constraints

  • Billing for Medicare Advantage patients (do not bill for HMO Hospice patients)

  • Is the tax ID or NPI numbers in HCH portal correct?

Is it OK to submit a care coordination claim to Medicare on the same date a patient in in the hospital?

Services such as care coordination that span a month, can have the situation where the date of service put on the claim (often the first or the last of the month—it varies) just happens to be when a patient is in the hospital.

It doesn’t mean that the care coordination services weren’t appropriately provided over the month. It is just a coincidence of dates issue. Medicare recommends use place of service = 99 on the MAPCP care coordination claims instead of place of service =11 to prevent this edit.

Questions for NGS About Denials?

Providers may choose to contact NGS with their questions.  Calling or mailing the questions would be their preference.

To contact the Provider Customer Service Department. please go to the www.NGSMedicare.com web site.

For Part B, then select “Resources” and then “Contact Us”, and select “Provider Contact Center”.

Illinois, Minnesota, Wisconsin: 1-877-908-9499, 1-866-234-7340, TTY: 1-877-236-7849

If you have already contacted Provider Customer Care Department and have either waited (at least 30 days) for a response  or are dissatisfied with the response, contact the Provider Outreach Department at J6.Provider.Training@wellpoint.com

They will need the Activity number assigned by Customer Care, the date you opened the request,  your facility’s Medicare legacy provider number, as well as a description of the problem, including any reason codes involved, and what you have been told by Customer Care.

Please include the claim number (ICN) if the question is claim specific.

More information on:

Requirements Overview
Quick Facts
MAPCP Quarterly Reports
MAPCP Billing Instructions and Webinars
MAPCP Steering Committee

Updated Tuesday, May 20, 2014 at 10:23AM