Hi Dr. Carroll and Donna, After following up with Amerigroup regarding the two accounts below, Amerigroup provided me with the information that was needed (when we rebill) in order for the UH to receive payment for services provided. I forwarded the accounts with the information to the Appeal Coordinator (Ed), in which, Ed informed me to forward the information to Gail Belsik, of Patient Accounts, to obtain the required information and/or bill modification. Below, you will find Gail’s response. There appears to be a discrepancy between the responsibilities of the Appeal Coordinator and the Director of Patient Accounts.
In regards to the post-dated check Tania needs to correct the deposit slip to show 17 checks and not 18. Next, she needs to place the copayment amount onto the patient's account as delinquent as she will need to collect this amount immediately. On the next business day not only does Tania need to contact the patient and advise them of the office's policy on post-dated checks and request the copayment immediately she needs to advise Susan on the policy as well. Susan should know post-dated checks violate state laws and health insurance policies. All patients required to pay copayments should do so on the date of service per their health insurance policy with cash, credit, or current date check for the appropriate amount nothing more or less.
On Tuesday July 7, 2015, at approximately 3:01 PM, Kiana Beekman, (MFCU Investigator) (Beekman) received a call on the state office telephone from HILL, Lucy (Service Facilitator of Lucy Hill Services (LHS). During the conversation, Beekman asked HILL to clarify her role and responsibilities as a service facilitator, in addition to the role and responsibilities of HARRIS, LaFrance as the Employer of Records (EOR) for Medicaid Recipient DANIEL, Rose and MCGHEE, Inocencia as DANIEL’s aide. She was also asked to provide any documentation of training on timesheet submission and approvals that she provided HARRIS and MCGHEE under the Department of Medicaid Services (DMAS) Consumer-Directed care aide program.
I done reviewing all the accounts just making sure that was a valid refund and I advise Jenilee so she can continue calling the patients for address confirmation and I can continue prepare the forms. The list that is complete is the Old list now I need to work on the new one that PMG FWD to us few weeks ago.
Service Coordinator (SC), Jennifer Stoker met personal staff, Aiesha Crayton at the home of consumer Jonathan .SC asked was Jonathan meet his outcome would like is medical expenses to cover. Aiesha noted he has Medicare and Medicaid which cover all his medical expenses. SC asked if money covering his want and needs. Aiesha noted yes. He wants and needs are being meet. Jonathan wants his cell to be paid every month. Aiesha noted he cell is being paid every month. SC asked is Jonathan maintain good health. Aiesha noted he when to his PCP on June the 1st. She noted he is health and there was no change in medication.
I am appealing for denial of my STD claim due to the following reasons. I submitted the claim on 07/22/2016. I was informed that within a couple of days my claim is going to be assigned to the claim manager, and the claim manager will discuss the following steps I need to take. A few days after I was contacted by Monique informing me that my treating physician will need to fax supporting information by 08/04/2016. I believe on 08/01/16 Monique reached out to me again stating that she has not yet received my information from my physician yet. According to my physician, the required information was faxed on 08/03/2016 and 08/04/2016. After these dates, I have not heard from Monique or my client manager Cheriane Zephy in regards to the progress or the approval/denial of my STD Claim. I reached out to Aetna numerous times trying to get in touch with my client manager. At every attempt, I was told by the customer service representative that my client manager either is away from her desk, cannot take my call, or out of the office for the day. Additionally, I was informed that according to their log, my client manager called me on 08/08/2016 and 08/09/2016, which is
When the mother and the patient came to her desk, she took care of entering the information need it, in the registration section of the electronic medical record form, asked for the insurance situation and gave the mother the admission and treatment form.
B.J. submitted the subpean that was issued with regard to the patient listed above. I am unable to attend the court hearing on 6/8/2017 because of the following: 1. the travel distance and 2. the time. Even though, I have someone that can pick up my children off the bus on occasions since her mother's car accident, it is not always guaranteed. Can you please reach out to the Attorney General and advise them of this matter and see whether or not a report is acceptable based on the request.
It was amazing how the Northern Group practices came together as a family for this patient; not only were all of us in the administrative part of the office working on this case, but the office manager from Northern Pediatrics came out of her way to go through this complicated website to assist with the approval. I saw first-hand how these small town medical office personnel fought for this patient to be seen and how much they each cared, it was breathe taking. I’m not certain if the approval for care went through or not, but I do know that the patient received care with or without knowing how the services would be paid for. I did ask what would happen if Medicaid did not approve the services provided, without worry or concern of payment Gail simply stated that the office would have to write off the charges. How these offices communicated and worked together for this patient was like something from a book or movie. I have never seen such care and concern for a patient and all the energy poured into this lady’s well-being, it was truly amazing to
Could you please advise? Appeal# 1090436 for claim# 125117839600 was worked by you on 05/19/2015. You upheld the decision. However, sent out a letter to the provider advising that it had been overturned. We need to know which decision was given on the appeal? If it’s different then the letter that was sent to the provider, another letter needs to be sent to the provider with the correct decision. If the letter is correct them the claims need to be reprocess for payment.
I appreciate your understanding and support with acquiring the updated medical records. Everyone has a vital role in the SCVRD Service Delivery System. Once the records are received and scanned into CMS, please send an email to Nikki and myself so that the case can be reviewed and a set of recommendations can be presented to Assistant Commissioner Annie Iriel. Remember, the objective is to keep this case moving forward. “Ms. Meek’s success is our
I review the patient account#12948701 and the account doesn't have any pending balance. I contact the patient and she only needs to know what is the process to get her BTL done.I advise the patient that she will need to contact the scheduling department and schedule appointment with the provider.Also I advise the patient that she need to come to see F.A department b/c her scale expired. The patient understood everything and she was agree to come to see the provider.
Please let me know if this is something we can work on and I think it would work better for me. I have included the hospital DCA in the correspondence.
I want to remind the providers if the case is so complex that they do not plan to dfollo the pt at the Hope Drive to schedule evals at the NE Drive.
A suit has been filed by the New Hampshire Hospital Association, along with several other NH hospitals against CMS over the treatment of dual eligibles in the calculation of uncompensated care for purposes of the DSH program. An initial hearing related to the suit is scheduled for early December. This hearing could potentially put the 2011 DSH recoupments on hold pending further proceedings. Similar suits have already been filed by other States/organizations and the outcome of these proceedings could eventually affect the
Teri, I still have not received a response from either you or Meggie. I cannot stress how important this is to resolve this issue asap. We have over half a million dollars that are owed to us and we want some action. But, more importantly, as I am sure that you are aware this issue is affecting some of your Medicare Advantage patients; as they reside in areas that have limited access to hospice providers and because PruittHealth’ s inability to get authorization from UHC due to incorrect provider load, they are having issues seeking medical care.