MISSISSIPPI MEDICAID : 96 - Non Covered Services Denial
- When MS Medicaid denied the claim as 96 - non-covered services then there could be two reasons, first, the patient enrolled in the CAN program then the claim should be billed CAN covered insurance and second is patient plan limited to family planning benefits, so the service is not covered under the patient plan.
- There are three insurance in the Mississippi CAN program, 1) Magnolia Health Plan, 2) United Healthcare, 3) Molina Healthcare
- Correct CAN insurance can be found through IVR by calling the insurance or on the website under "Lock-In Information" by checking patient eligibility.
- Under "Lock-In Information", you will find the insurance enrollment date with the plan sponsor/insurance name.
- To bill, the claim to CAN insurance, use the same policy ID of MISSISSIPPI Medicaid.
- Under "Eligibility Information" on the website, you will find patient plans limited to family planning benefits or not.
- If the patient's plan is limited to family planning benefits then the claim should be written off since billing claims to patients on Medicaid is not allowed.
Very helpful
ReplyDeleteSuper Bro. ya its really helpful...
ReplyDeleteThank you. Good to hear that.
DeleteFrom Medicaid denied ' RECIPIENT ENROLLED IN MCO- CALL EVS FOR FURTHER INFORMATION ' what does this meaning and what the next step.
ReplyDeleteFind out if patient has any managed care insurance on the date of service by checking eligibility on web portal or IVR. You will find the managed care insurance under "Lock-In Information" as mentioned in the above post. If you find the managed care insurance then submit the claim to that insurance.
DeleteThank you for your response.
DeleteCould you please tell us what is CAN program & it's full form
ReplyDeleteThe CAN program stands for Coordinated Access Network program.
DeleteThis program increases medical service access, quality care and cost prevention.
hello
ReplyDeleteHi
DeleteThis is very helpful. Thank you!
ReplyDeleteThanks!
DeleteWhat to do if noncovered denial occurs from MCO i.e medicaid managed care plan? Can we bill to original medicaid if we get such denial from MCO? Will medicaid cover for non covered denial from MCO?
ReplyDeleteIf the responsible party is MCO then billing the claim to Medicaid will not help. Medicaid will deny the claim stating it is covered under a managed care plan.
DeleteTry to confirm the non-covered reason, sometimes it is coding related issues that can be resolved.
Can we bill patient if such denial is from MCO but not Mississippi Medicaid itself?
ReplyDeleteNo, it should not bill to patient and it would be good if you confirm this with your client.
Delete