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Thursday, July 1, 2010

Eligibility related denial claim

Denial - BENEFICIARY ELIGIBILITY

Description: 

You submit a claim for processing and the beneficiary/patient does not have Medicare eligibility. Claims are often denied for eligibility for the following reason:
* The beneficiary Medicare number is invalid on the claim.
* The beneficiary is not eligible to receive Medicare benefits.
* The beneficiary's claims must be filed to another insurance plan.



Action :
Screen your patients. Verify the Medicare number on the patient's Medicare card and file the claim exactly as it is printed on the card. Verify the patient's effective date for Medicare Part B from their Medicare card. Medicare cannot pay for services prior to the patient's effective date and will not pay for services if the patient has terminated his Medicare benefits. Beneficiaries who enroll in a Medicare "replacement" HMO must be submitted to that insurance plan instead of Medicare Part B. To obtain Medicare eligibility, call your carrier's Provider Service department.

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