Cigna responds within 30 days of receipt, advising that it needs an Exhaustion of Benefits notice from the patient’s no-fault policy issued by the driver’s automobile insurance carrier. The treatment source on the claim form is properly listed as a motor vehicle accident and Cigna is billed, well within the 180 day contractual filing limit. In fact, if the MCO were to pay anything at all, it would only be after the commercial plan pays – and the MCO usually covers less and pays less. ![]() Knowing that Medicaid is the payer of last resort, the hospital realizes the MCO is not responsible and does not bill the claim to the MCO. The hospital promptly confirms the patient has coverage with Cigna’s commercial (employer-based) health plan and also with United Healthcare’s Medicaid HMO product (“MCO”). ![]() The patient receives emergency services and is eventually discharged for injuries associated with a motor vehicle collision. While this issue can happen for any patient covered by two or more health plans, claims for patients involved in automobile collisions are often high dollar, and thus high risk. Since both scenarios are not mutually exclusive, ER physician practices and hospitals are especially prone to untimely billing in the coordination of benefits context. The patient is covered by a commercial health plan and a Medicaid HMO (“MCO”).The patient is involved in a motor vehicle accident or.This problem occurs mostly in two scenarios: As a result, they must write off the entire unpaid balance for the technical denial of untimely filing. One situation referred to my practice is a contracted provider fails to initially bill all potential payers. To Avoid Untimely Filing Denials, All Potential Payers Must be Billed Initially, Especially with MVA and MCO Accounts.
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