What if a member has BMC HealthNet Plan coverage after he or she is discharged from care?
You will need to appeal the claim denial by submitting a written explanation that details why the member’s eligibility was not verified prior to services being rendered. How do I care for a member who doesn’t have an ID card? You should always verify member eligibility at the time of service to ensure coverage. If this is done, you will be provided with the Plan’s number and you should make sure that you are the PCP for primary care services. As long as the member’s eligibility is verified on the date of service, we will pay associated claims. If you are a specialist and the service being rendered requires prior authorization, you will need to contact the member’s PCP to seek authorization. When billing code 86580 Mass Health requires an invoice, does BMC HealthNet Plan? In most cases, the requirements of MassHealth are the same as the Plan. As a result, if you provide invoices to MassHealth for a code, it is best to supply one to the Plan to ensure clean claims processing. When billin
