EXPRESS CLAIMS

Midwives Covered?

caroline — Thu, 17 Feb 2011 21:28:16 +0000

When asking if Midwives are covered be sure to define the Midwife type. Many Licensed Midwives are experiencing denials because plans are only covering Certified Nurse Midwives. It is important to ask the Insurer if Licensed Midwives are covered and then to go one step further and ask “Are there any exclusions on the policy?” Often out of state plans will require Midwives to be Certified and supervised by a physician there are also some self funded plans requiring this also. Make sure you are covered by being very specific. Some insurance representatives still have not had the “Do you cover home births ” question.

Medicaid code changes

caroline — Thu, 17 Feb 2011 21:20:36 +0000

Medicaid is now only paying for certain Rhogam meds. If you are not using the ones that are payable on their list they will not reimburse you. Your NDC must match. Check out the information below from Florida Medicaid

Provider Type(s): 25, 26, 29, 30, 34, 69, 77, 78, 97

Rho D Immune Globulin Injections (J2788, J2790 and J2791)

The manufacturer of RhoGam does not participate in the federal drug rebate program. Since July 1, 2010, all RhoGam claims have been rejecting. This banner alert is being published to redirect providers to Rho D Immune Globulin products that are covered by Medicaid.

Rho D Immune Globulin Injections products that are currently participating in the rebate program are:

J2788 – HyperRho
J2790 – HyperRho
J2792 – Rhophylac

The National Drug Code (NDC) for physician administered Rho D Immune Globulin products must be listed in conjunction with the appropriate HPCPS codes. The NDC is found on the drug container (vial, bottle, or package box). The claim must reflect the exact NDC codes found on the product package/container from which the medication was administered.

Feel free to contact us with any questions!

Florida Medicaid Re-enrollment

caroline — Wed, 07 Jul 2010 17:07:20 +0000

Per the Summer 2010 Medicaid bulletin “Provider Reenrollment has begun!” This process has been simplified and should now be more streamlined than before.Medicaid advise that “Ninety (90) days before your Florida Medicaid Provider Agreement expires, you will be sent a reenrollment packet. Providers whose agreements have already expired will be among the first to receive a reenrollment packet. If your agreement is expired, be alert for these packets in your mailbox in the coming months.

Medicaid states “You will have ninety days to complete the reenrollment process. If you have questions regarding completion of your packet, the Florida Medicaid Reenrollment Guide should have the answer.
You must complete the reenrollment process by the deadline specified in the reenrollment packet. After that deadline, the system will automatically suspend your claims for review until you complete the process. To avoid disruption of your claims processing and payments, submit your reenrollment packet immediately after you receive it.

For more information on this and other Medicaid issues check out http://ahca.myflorida.com/Medicaid/

A Midwifes Dilemma

caroline — Wed, 03 Mar 2010 02:50:33 +0000

Often, when accepting a new client into care many Midwives are faced with the dilemma of should I spend my valuable time on the phone verifying benefits or simply put it off and do it later. This approach of “doing it later” can often be a costly choice. Just because an insurance plan looks familiar to one that paid well before doesn’t mean that coverage is the same for all plans. Now, more than ever plans are changing and so too are the benefits.

It is very important that before your cleint enters care you know exactly what their policy will and will not cover and if an authorization needs to be obtained. There are some insurance companies that simply will not back date an authorization and you don’t want to lose any payments for services you’ve provided. Medicaid HMO’s are a good example of this and often will bounce members in and out of straight Medicaid. Therefore, it is always best to check before every visit for your Medicaid clients.

If you are finding it hard to find the time to sit on the phone with insurance companies or simply “loathe” that side of the business then you may want to consider an experinced Billing service to handle those calls for you. Either way finding out ahead of time what the insurance policy covers is definitely a good decision.