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HomeHomeDiscussionsDiscussionsManaged CareManaged CareThird Party Liability Notices - HorizonThird Party Liability Notices - Horizon
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11/21/2011 4:15 PM
 
On November 11, Horizon's Cost Containtment Department (located in Philadelphia) starrted sending letters retroactively denying medicald day care claims due to a perceived primary insurance carrier.  Calls to the help dek generated a resonse that providers were reqired to file those claims, recieve an EOB, and, assuming the "primary" claim was denied, then submit a hard-copy claim to Horizion along with the EOB as an attachment.  On the specifical claim denial lists sent out, we noticed that, in most cases, the "primary payer" was Medicare Part B.  Needless to say, there is no Medical Day Care Coverage under Medicare.  We finally reached George Ingram, Director of Provider Networks for Horizon NJ Health, who agreed with us that this was a mistake.  He indicated that he would be on the road until November 22nd, but promised to rectify the matter and notify us on November 23rd.  Our recommendation is to delay any actions until after that date, at which point we will update this forum with the results of Mr. Ingram's initiative.  If this is not resolved, we will recommend that you file appeals with the Cost Containment unit in order to delay any adverse action.  The only claims, at least with Horizon NJ Health, that will require "primary carrier" filings are for clients with commercial insurance, since some of those policies do cover medical day care. 

It appears that this same problem is beginning to arise with the other Medicaid HMOs, and we will keep you informed.
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4/23/2015 11:42 AM
 
Interesting post. Thanks
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HomeHomeDiscussionsDiscussionsManaged CareManaged CareThird Party Liability Notices - HorizonThird Party Liability Notices - Horizon