RE: Immuno's being covered [1 Attachment]

[Guest guest]

Thank you Deidra! Having these codes and

knowing where to enter them is something that pharmacies may need help with. I

had a patient with a BCBS of Massachusetts Medicare supplemental plan and the

patient’s local CVS pharmacy could not run it to pick up the 20%. I

called our hospital pharmacy who told me where (what field in their billing) to

have the CVS enter the BCBS ID number – 30168 – and it worked. The

pharmacy said they had not used this process before ....

Daryl Battin

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Ms. Daryl

Battin, MSW/LICSW

Financial

Coordinator/Social Worker

Department of

Transplantation

Lahey Clinic, 41 Mall Road, Burlington

MA 01805

Ph:

Page:

FAX:

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Deidra M. Simano

Sent: Tuesday, May 15, 2012 8:34

AM

To:

TxFinancialCoordinators

Subject: RE: [Marketing Mail]

[Caution: Message contains Suspicious URL content]

Immuno's being covered [1 Attachment]

I have been working closely with our outpatient pharmacy to

avoid those discharge medication issues that can be so much of a

nightmare. They use something called a COBA code – if the pharmacy

bills Medicare B for immunos with the appropriate COBA code on their

claim, then it should process with no copay for the patient – when

appropriate.

I have attached a list of insurances with the COBA codes that

our pharmacy biller gave to me. They are a separate business entity from

us and do not have access to our system for the most up to date insurance

information. I have started providing them with the patient’s

insurance information on the day of transplant, which has helped things go more

smoothly.

Deidra M. Simano

Transplant Operations Analyst

Department of Transplant Surgery

Dartmouth-Hitchcock Lebanon

Phone: (603) 653.3689 / Fax: (603) 676.4287

Transplant Secretary (603) 653.3931

Dartmouth-Hitchcock.org

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of on, :LPH Trnsplnt

Sent: Friday, May 11, 2012 4:24 PM

To: TxFinancialCoordinators

Subject: RE: [Marketing Mail]

[Caution: Message contains Suspicious URL content]

Immuno's being covered

I’ve been told by our

pharmacy that if the crossover claim info is set up in Medicare, the 20%

coinsurance billing should go through without problem. This could be

nonsense but it does SOMETIMES seem to be a solution.

on

Transplant Financial Coordinator

Legacy Good Samaritan Hospital

Legacy Transplant Services

1040 NW 22nd Ave Ste 480

Portland OR 97210

direct

main office

toll-free

fax

lmorriso@...

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Vazquez, L.

Sent: Friday, May 11, 2012 1:06 PM

To:

TxFinancialCoordinators

Subject: RE: [Marketing Mail]

[Caution: Message contains Suspicious URL content]

Immuno's being covered

I will call the commercial plan and ask them if the

patient pays the 20% , will they work with them to reimburse them back.

Thanks so much for all the answers

Sam

Vazquez

Kidney Transplant Financial Coordinator

Providence Sacred Heart

Medical Center

Kidney Transplant Program

105 W Eighth

Ave Suite 1000

Spokane, WA 99204

Tel: /

Fax:

samantha.vazquez@...

This electronic transmission and any documents

accompanying this electronic transmission may contain information that is

confidential and/or legally privileged. The information is intended only for

the use of the individual or entity named above. If you are not the intended

recipient, you are hereby notified that any disclosure, copying, distribution

or the taking of any action in reliance on or regarding the contents of this

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immediately.

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Battin, Daryl J.

Sent: Friday, May 11, 2012 1:03 PM

To: TxFinancialCoordinators

Subject: RE: [Marketing Mail]

[Caution: Message contains Suspicious URL content]

Immuno's being covered

When Medicare is primary to a commercial insurance, there very

often is not a Medicare crossover process for the commercial insurance

(compared to Medicare supplemental plans) to pay the pharmacy for the 20%.

So the patient ends up paying the 20% and then working with the

commercial insurance to reimburse that 20%. They often have to wait until

they get their Medicare EOB stating what Medicare has paid before they can

submit for reimbursement to their commercial plan. This ends up being

something we have to prepare patients to have the funds to cover.

Daryl Battin

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Ms. Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation

Lahey Clinic, 41 Mall Road, Burlington

MA 01805

Ph:

Page:

FAX:

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Vazquez, L.

Sent: Friday, May 11, 2012 3:27 PM

To: TxFinancialCoordinators

Subject: RE: [Marketing Mail] [Caution:

Message contains Suspicious URL content] Immuno's

being covered

They do have Medicare Part B primary. Blue Cross Blue

Shield of New York

is stating the prescription portion needs to cover as they will not. Then when

you contact the prescription benefits, they state they are to be billed primary

or they will not pay and as you all know, we cannot do this.

Vazquez

Kidney Transplant Financial Coordinator

Providence Sacred Heart

Medical Center

Kidney Transplant Program

105 W Eighth

Ave Suite 1000

Spokane, WA 99204

Tel: /

Fax:

samantha.vazquez@...

This electronic transmission and any documents

accompanying this electronic transmission may contain information that is

confidential and/or legally privileged. The information is intended only for

the use of the individual or entity named above. If you are not the intended

recipient, you are hereby notified that any disclosure, copying, distribution

or the taking of any action in reliance on or regarding the contents of this

electronically transmitted information is strictly prohibited. If you have

received this e-mail in error, please notify the sender and delete this message

immediately.

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Danner, Sara

Sent: Friday, May 11, 2012 12:26

PM

To: TxFinancialCoordinators

Subject: RE: [Marketing Mail]

[Caution: Message contains Suspicious URL content]

Immuno's being covered

Immunos shouldn’t be billed to prescription plan at

all. Part B and BC/BS medical coverage should be paying.

Does patient have Part B?

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ]

On Behalf Of Vazquez, L.

Sent: Friday, May 11, 2012 2:22 PM

To: TxFinancialCoordinators

Subject: [Marketing Mail]

[Caution: Message contains Suspicious URL content]

Immuno's being covered

Hello,

Is anyone else experiences

problems with Blue Cross Blue Shield plans covering immunosuppressive

medications? The problem I seem to be having is when the BC BS plan is

secondary to Medicare and the prescription plan under Blue Cross Blue Shield

request to be billed primary. They are denying claims and leaving our patients

with huge bills. Any suggestions or comments???

Thanks,

Sam

Vazquez

Kidney Transplant Financial Coordinator

Providence Sacred Heart

Medical Center

Kidney Transplant Program

105 W Eighth

Ave Suite 1000

Spokane, WA 99204

Tel: /

Fax:

samantha.vazquez@...

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