Wiki Medicare to Medical Advantage

[daharden]

Patient was inpatient beginning 12/2017 under traditional Medicare, and then 1/1/18 switched to Medicare Advantage. The Medicare system will not take our SNF claim, any clue on what codes we need to add to get them to not automatically reject it because patient was under a MA plan on those DOS?

 

[CodingKing]

My understanding prior payer only covers if its inpatient but not SNF. At least thats what this says from UHC. (PS there are links to the Medicare Claims Processing manual on the PDF linked)

https://www.uhcprovider.com/content...le-hospitalized-acute-ltc-snf-home-health.pdf

I.2.a

Hospitalization in a Medicare certified skilled nursing facility (SNF)
UnitedHealthcare is responsible for all services beginning on the member’s effective datewith the UnitedHealthcare Medicare Advantage plan.