07/07/2018

Managed Care Committee Reimbursement TIDBITS

Featuring this month: Total Health Care, Inc

TidBits thanks to 

MSHO

Did you know...

...The filing limit policy for THC is 365 days from the date of service.  Appeals and resubmission of unclean claims must be received within 180 days from the original denial date.

Did you know...

...THC follows Medicaid billing guidelines for all lines of business.  CMS edits apply according to Medicaid rules. (per their website)

Did you know...

...THC is supposed to offer the same medical benefit as traditional Medicaid.  MSHO is currently working with traditional Medicaid and the CMS Regional office to enforce this regulation, as some of the prior authorizations on drugs are not being allowed or step edits are in place for some drugs which are not required by traditional Medicaid - stay tuned as MSHO continues to work on this issue.

NOTE: A different Michigan Payer will be featured monthly.

 Visit the MSHO Website for a listing of the Michigan Health Plans and the MSHO Managed Care Committee.

CLICK HERE