Backdating healthcare provider contracts

05-May-2019 02:19

This 15% balance billing amount applies to providers who have a written contract with the Medicare Private Fee-for-Service Plan or who have met certain company conditions.

AHCCCS Medical Assistance is a joint Federal and State program that helps pay medical costs for beneficiaries with limited income and resources.

AHCCCS sends notification of all buy-outs to CMS on the 24th or 25th of each month.

Since it may take one to three months for the buy-out to be processed, the beneficiary may have two or three month’s premiums withheld from one month’s Social Security benefits when Medicare processes the buy-out.

For example, a person may get coverage for nursing home and home health care.

NOTE Prescription drugs are not covered by Medicaid when the customer is entitled to or enrolled in a Medicare Part D plan.

The file goes to CMS on the 24th or 25th of each month.

CMS processes the file and responds the 5th of the following month on the acceptance or rejection of the individual records.

The rebate may come in the form of a separate check depending on when the change is processed by SSA or if the individual does not receive Social Security benefits.If the beneficiary has COBRA coverage, they must enroll during the 8-month period that begins the month after the employment ends.This Special Enrollment Period does not apply to people with End Stage Renal Disease.The processing period begins the day after the application date and ends on the date that the decision letter is mailed.For the application to be timely, the letter must be mailed within the processing time frame.

The rebate may come in the form of a separate check depending on when the change is processed by SSA or if the individual does not receive Social Security benefits.If the beneficiary has COBRA coverage, they must enroll during the 8-month period that begins the month after the employment ends.This Special Enrollment Period does not apply to people with End Stage Renal Disease.The processing period begins the day after the application date and ends on the date that the decision letter is mailed.For the application to be timely, the letter must be mailed within the processing time frame.The mailing date is the first business day after the decision has been processed in the system.