Charges are covered under [capitation agreement] or [managed care plan]

[@TusharKumar-or3vb]

Fantastic keep doing this work 👍

[@abhinavkishore1758]

Thanks 👍

[@vivek4143]

Thanks bro

[@kishankeshri6389]

Thank you !🙏🙏

[@dminmb]

You are so welcome!

[@kishorevemula9111]

If pt has medicare advantage plan & medicare plan can we bill both or which is primary??

[@rohitvaishya8675]

If the pt is eligible for Medicare then only he is eligible for Medicare part c so when he has Medicare part c then if u billed the clm to traditional Medicare then Medicare will dnd the clm charges are covered under managed care plan so in that sense u have to bill to medicare advantage

[@rajayasirmanzoor4220]

Kindly share the entire solution of this denial.

[@sammyanytime100]

Nice, Bro I have a question. I was working on a UHC claims where the claim is denied as under capitation agreement.
What should be the action over here?

[@dminmb]

If provider is enrolled in capitation agreement on your date of service.. provider need to adjust the balance... That means provider need to write off the balance

[@crazyboys6289]

Ll

[@crazyboys6289]

L

[@rohitvaishya8675]

Ask him the capitation period of the your dos lies within that period than adjust or write off the Ballance if not ask for reprocess or appeal

[@scooby_the_beagle]

can't understand capitation denial clearly

[@dminmb]

Ok.. capitation agreement is just like job to doctor.
Where insurance pay to doctor @ per patient basis.. not at single service basis...
Usually doctors charge for every single treatment...
In capitation case it is per patient basis...

[@scooby_the_beagle]

@@dminmb thank you

[@dminmb]

Welcome!🙂

[@RaviSingh-kj1pm]

Incomplete information provided if you need i can give you the complete follow question and and also I can explain what is capitation in medical billing.
Thank you