Dec 4th, 2018 - ChrisW 256 1
This is an open-ended question.
Be sure you are billing either Part A or Part B and the correct Place of service approved for the treatment.
Who is the monthly capitation payment provider? I am assuming you have pre-authorization and you are billing under the correct approved physician.
Are you billing per Month or per day (Term means calendar month)? Is anyone else submitting claims?
If all else fails, I would suggest contacting your Medicaid Provider Representative for coverage and benefits to see what is covered, or if it is an exclusion of the patient's benefits. Be sure to verify where the claims are being sent it looks like they use Magallan, so you may be sending the claim to an incorrect address. Are you billing the correct code allowed for the age? What about the Place of service being billed? There is a lot to consider, I hope this helps, I don't see any indication that these codes should not be payable if billed correctly.
Hope this helps.
Here is a link on ERDS for AR Medicaid.
Here is a Fact SHeet from CGS Medicare as well.