Question

According to Medicare guidelines, what should a provider do if a claim has not been paid after thirty days?

Answer 1

According to Medicare guidelines, a provider should contact the MAC or Medicare Advantage Plan, consider submitting an appeal or request for reconsideration, and seek legal action if necessary if a claim has not been paid after thirty days.

Step-by-step explanation:

According to Medicare guidelines, if a claim has not been paid after thirty days, the provider should take the following steps:

1. First, the provider should contact the Medicare Administrative Contractor (MAC) or the Medicare Advantage Plan to inquire about the status of the claim and to address any potential issues or errors.
2. If the claim remains unpaid after this initial follow-up, the provider should consider submitting an appeal or requesting a reconsideration of the claim. This process involves submitting additional documentation or supporting evidence to support the validity of the claim.
3. Lastly, if all other avenues have been exhausted and the claim still remains unpaid, the provider may need to seek legal action or consult with a Medicare attorney to explore further options.