Wiki Denials on Maternity Benefits from Primary Payors

[cdeleon78]

We are having an issue receiving quite a few denials as a result of pt's not having or being eligible with their primary payor for maternity benefits, then having to wait to get a denial from the primary w/the EOB to submit to the secondary (which is usually after delivery and after filing deadline). Our issue is that charges are not usually entered until after the delivery and by the time denial is sent there is not enough time to file the antepartum visit without being past appeal.

Does anyone have any thoughts on how we could get this issue resolved or a process to better workflow?

Thank you,

Cindy

 

[srobinson@womensmd.com]

We verify coverage before seeing the patient for the first OB visit. This way we can tell if the patient has a large deductible or out of pocket. It has helped us a lot as our state has a medicaid plan specifically for pregnant women with high deductible coverage already in place.

 

[nlchavez]

Verify coverage

We experience the same issue, but verifying coverage and being really proactive on the front end has helped. It's especially important, for minor patient's that are covered under parents plan and don't know the coverage information. Medicaid will know the majority of the time if there is a primary insurance. If you do recieve denials for past the timely, you can always appeal using the proof of what you have filed and the payer will accept it. (lots of tedious work, but it will get paid).

Hope this helps!