Wiki Split Billing Maternity Care

[KelkeyJane]

I have a patient we were seeing for maternity care that had Premera primary and Molina Apple Health secondary. Her Premera termed and Molina became primary halfway through. I billed Premera for global antepartum 59425 (5 visits) and that claim ultimately went to Molina, but they didn't pay anything (OA-23). When billing Molina for the other half of her antepartum care (59425 for 5 visits), they denied it stating they were already billed for that service. I appealed the claim with an explanation of the circumstances and EOBs and the antepartum claims had different DOS, but they upheld the denial. How do I get around this situation?

 

[Dzehrung]

It sounds as if it were a self funded plan, Molina would be responsible for the global if that were the case.