Can we billed Medicaid patient for Medicare coins ?
Can you clarify if Medicaid only covers Medicare part B premium? Is the patient responsible for the 20% coinsurance?If you are referring to persons who only have coverage as Special Low Income Medicare...
View ArticleWhat is Medicaid Share of Cost - explain with example
Can you please let me know how to check eligibility on share of cost patients?A Medically Needy recipient is an individual who would qualify for Medicaid, except that the individual’s income or...
View ArticleMedicaid THIRD PARTY LIABILITY (TPL) - During eligibility
When checking eligibility, sometimes, there is COMMERCIAL INSURANCE listed on the Medicaid website as primary payer. After checking the primary payer websites, I find that the commercial insurance has...
View ArticleBasic billing question on Medicaid Managed care
MANAGED CAREHow do we find out which network provider to call?If you check eligibility through the web portal, look for this information in the Managed Care section of the recipient’s eligibility...
View ArticleDo we need to save verification eligibility screen as a proof
How do I document verification of recipient eligibility?You can obtain a call reference number through the AVRS. If you use the Web Portal you may choose to save a copy of the screen print or print out...
View ArticleWhere do I submit claims to MediPass?
Where do I submit claims to MediPass? What is the claim address and can it be submitted electronically? I have contacted different Medicaid provider phone numbers, but I have not received any response...
View ArticleMedical billing basic terms, definitions - capitation fee, covered services,...
“Capitation Fee” means the monthly payment made by CarePlus to the Provider for each Enrolleeassigned to Provider. The amount of the Capitation Fee is set forth in the PCP Agreement.“Clean Claim” is a...
View ArticleWhat is Interdisciplinary Care Team, Medical Group, participating physician
“Interdisciplinary Care Team” or “ICT” refers to interdisciplinary services provided by atreatment team in which all of its members participate in a coordinated effort to benefit the patientand the...
View ArticleDefinition - primary care physician, QIO, specialist physician, subscriber
“Primary Care Physician (PCP)” means a Participating Physician who supervises, coordinatesand provides primary care services to Enrollees, including the initiation of their referral for...
View ArticleCan provider bill patient for mised appointment
MISSED APPOINTMENTS:* Missed appointments by the member must be followed-up by the Provider.The CarePlus Member Services Department will assist the Provider in this process if necessary. If thepatient...
View ArticleDoes insurnce cover Family planning services - SHP insurance
Family Planning Services - Family Planning Services include education, information, referral,counseling, diagnostic procedures and contraceptive drugs and supplies. Members have freedom of choice in...
View ArticlePatient's rights and responsibilities at provider office
Member’s Rights & ResponsibilitiesSHP Members have the right to:* be treated with courtesy and respect, and with due consideration of his/her dignity and privacy.* receive information on...
View ArticleWhat is Quality improvement program
OverviewSHP maintains an active Quality Improvement Program (QIP) that provides structure and processes for our ongoing commitment to proved and continually improve upon the care and services that are...
View ArticleCREDENTIALING - How to do with SHP insurance
OverviewSHP is responsible for all aspects of the credentialing and recredentialing process for all providers who join or participate in the SHP Network. This process is under the QI Department and is...
View ArticleSubmission of Formal Grievances and Appeals: to simply health care insurance
Providers are encouraged to first communicate any concerns or dissatisfaction about an SHP process or decision verbally through the Provider Relations telephone lines at 1-800-887-6888 ext. 6005 Monday...
View Articleclaim submission guideline form SHP
Claims SubmissionClaims are to be submitted to Simply Healthcare Plans with appropriate documentation by mail or filed electronically for CMS-1500 and UB-04 claims. For those members that may be...
View ArticleCMS STAR RATINGS
The Centers for Medicare & Medicaid Services (CMS) uses a five-star rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system....
View ArticleWhat is MEDICATION THERAPY MANAGEMENT (MTM)
Purpose: ** To optimize therapeutic outcomes for individual patients. ** Optimize drug therapies. ** Improve medication use. ** Reduce risk of adverse events and drug interactions. ** Increase patient...
View ArticleMember Enrolled in hospice ? Does Medicare HMO covers the service?
What is Hospice? Hospice is a program of care and support for people who are terminally ill. It is available as a benefit under Medicare Hospital Insurance (Part A). The focus of hospice is on care,...
View ArticleHospice CPT Coding FAQ
How do I bill for hospice services? The following is an excerpt from the “Part B Answer Book” CD-ROM. Hospice Care: Overview If one of your patients has a terminal illness, with about six...
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