Nov 27, 2014 | Medical billing basics
1. What if I want to change plans? If you have been approved for Medicaid, you may change your plan during the first 90 days of your enrollment. After the 90 days you will only be able to change your plan during your open enrollment period or with a...
Nov 29, 2013 | Medical billing basics
Claims From Medicare Advantage Organizations Federal regulations require that Medicare fee-for-service contractors maintain payment responsibility for managed care enrollees who elect hospice. These regulations are found that Medicare Fee for Service retains payment...
Apr 23, 2013 | Medical billing basics
MANAGED CARE How 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 screen. You will find the name, type and phone number of the HMO, PSN...
Jan 3, 2011 | Medical billing basics
Effective January 1, 2011, Health Options, Inc. (HOI) is instituting a change in the member referral process for all Medicare Advantage (BlueMedicare® HMO and BlueMedicare® Group HMO) members. Notification of a member referral is required when: PCP refers a member...
Dec 28, 2010 | Medical billing basics
HMO: Need a referral from PCP to see a specialist. Need to select a PCP with in network Low premium Dose not covered the out of network service PPO: Don’t need a referral from PCP to see a specialist. Don’t necessary have to choose a PCP High premium dose cover the...
