How do we handle billing when an HMO patient, who is receiving home health services from us, disenrolls from the HMO and is eligible for Medicare?

If a patient disenrolls from a Medicare Advantage (MA) plan (also known as a Medicare HMO) and is eligible for Medicare home health benefits, a new start of care would begin as of the first billable visit after the termination date of the MA plan election. The home health agency (HHA) should confirm that the termination date has been updated on the Common Working File by the MA plan. This information is available for Direct Data Entry providers on Page 1 of the Health Insurance Query A (HIQA) screen or Page 5 of the Health Insurance Query for HHA (HIQH). If the termination date is not updated, final claims will reject.

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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