Wiki FQHC - Medicare Advantace Plans Billing

[joycejackson]

Our Humana MA claims are currently being billed out the same way we bill traditional Medicare? We are having an issue with Humana processing the claims with the patient owing 40% of the allowable for the G-code? This is coming out to be a coins of $52.00? Can you tell me how you all bill your claims to the Medicare Advantage Plans? With an FQHC is it correct that Medicare Advantage Plans should be paying our Medicare Encounter Rate?

I believe we need to be doing the wraps, but how are we to get started getting these payments?

I thank you for any help you can provide and for your time in assisting me.

Thanks!

 

[rcj0401]

If you are billing the way you do MCR then you are doing it right. I would call Humana. We had the same issue and were told they were processing our claims like an ER/Urgent Care and it was an internal issue. Hope this helps.

 

[Chelle-Lynn]

I agree, generally when there is a payment problem with a Medicare Advantage Plan, it because most of these plans are unclear on how to recognize or process the claims for an FQHC. Generally working with the contracts division will help get this resolved.