Healthcare claims - Managed care/Hospice how to bill?

This may be a long shot, but can anyone here explain how to get a Medicare replacement plan (such as Humana Gold Plus Managed Care plan) to pay a claim for a skilled stay at a nursing facility when Hospice is involved? I have no problem billing Medicare directly when someone has Hospice but is being treated for a non-hospice related illness...I just use a condition code 07, but I can NEVER get any of my Humana part A claims to pay in this situation unless I bill Humana, get a denial that says I have to bill medicare, bill medicare and get a denial saying the person has a managed care plan, and then bill humana over and over again. I've actually got close to $40k on my aging that's over 120 days old and I really need to get those claims paid!!!! Any help???

They eventually pay...but not for 10-12 months. The EOBs from Humana always say "if diagnosis not related to terminal condition, bill Medicare directly." I know Medicare will not pay, because the member has Humana, but this is what Humana requires every single time. I'm just wondering if there's a way to let Humana know that this is a non-terminal diagnosis claim at the time I submit it. I use www.availity.com to submit my Humana claims, which isn't necessarily using a UB92 or UB04...is there a way to get the claim to pay the first time around if I use a UB04 with some specific condition code or something? Like an 07 or perhaps a GW?

This is a little out of my relm of expertise but when I ran a home care company we had to get something called a "demand denial". It was a form that the patient had to sign saying this service was not covered under their insurance and to bill Medicare.

I think my company created these forms but it saved hundreds of dollars and time.

We had to submit this form with the denial from the insurance company so it wasn't a clean claim. We still had to wait for the insurance co. to issue the denial but then with this form we could get paid pretty quickly.

http://www.AngieMilhous.com

Why doesn't Humana pay? This doesn't make sense. Humana Gold is a replacement, but that doesn't mean they cover everything traditional medicare pays. Are you using the new UB04s?

I know services for non-terminal illness are paid by normal medicare & not as part of their hospice package. They're only eligible for their hospice package if they agree to it and are declared terminally ill. So, maybe they aren't in an approved medicare facility, or hospice program? Maybe getting an authorization @ humana prior to services being rendered would help facilitate claim payment in the long run. Appeal it. and look at the PDF file on www.cms.gov regarding how to bill inpatient hospice claims for non terminal patients.