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sundberg101
Premolar II

Generating continuing treatment claims every 6 weeks

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So we just found out that our state's Medicaid program is proposing changing from a quarterly to a 6 week continuing treatment claim cycle. Most of us insurance people are now scrambling to figure out a way to handle this change within our various software programs.  I've already sent off a letter to be read at the hearing stating that this proposal is so outside the industry norms that most practice management software programs do not have the capability to post recurring charges or submit continuing treatment claims on a 6 week cycle. If this proposal passes next month I need a solution on how to restructure the contracts and generate continuing treatment claims every six weeks.  Do you have any suggestions for me?

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Re: Generating continuing treatment claims every 6 weeks

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Good day Laura ( @sundberg101 ),

As you mentioned, an idea like that is completely outside the norms of what is considered accepted practice in the industry; and it is also the first time I have even heard of such a thing.  Accommodating claims and/or contracts which are run on a frequency that is not some multiple of "monthly" (that is, monthly, quarterly, semiannual or annual)  would require a complete rewrite of the entire contracts and claims system in OrthoTrac -- in other words, there is no way it could be implemented any time soon.  Can you provide details of this proposal?  Do you have anything in writing such as a letter that was sent to your practice, an online link to a site detailing the proposed changes, etc.?

Regards,

Phil Carter / OrthoTrac Escalations

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sundberg101
Premolar II

Re: Generating continuing treatment claims every 6 weeks

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It is our understanding that Washington states Medicaid program is switching to an initial payment that covers the first three to six months of treatment (depending on if it's limited or comprehensive treatment), then we can submit for continuing treatment payments every six weeks. They will also change the wording in the billing/treatment guidelines that requires patients to be seen at least twice in a quarter (and paying quarterly) to wording that states we need to see the patient at least every six weeks (and in turn they will pay every six weeks) but any additional visits within each six week time period would not result in additional payment. 

They held a meeting two days ago about it and it's my understanding that the six week payment issue was not discussed much. The focus of the meeting ended up being about the legality of collecting a broken bracket fee when Medicaid patients break brackets and whether or not we can seek reimbursement from the patient or will Medicaid start paying for it or create a rule about how many are covered prior to requiring patients to pay.

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