I do medical billing, prior to billing Molina Medicare I always check on the Noridian Medicare website to verify the patients deductible has been met. Once met, I send claims to Molina Medicare,they still take deductible from claims then pay the Medi-Cal rate.
I call them each time this happens and they give me a reference # and say they will reprocess...they rarely do and when I call them back on claims not reprocessed they say they did an "internal" denial that is why I did not get payment and explanation of denial. Billers need to pay attention, as when patients have dual Molina coverage,Molina wants to pay Medi-Cal rate for claims.
Product or Service Mentioned: Molina Healthcare Medical Claim.
Reason of review: Problems with payment.