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Brookadam, I'm up and about is the only reason I'm responding - unfortunately I'm in the UK and therefore haven't a clue, but don't go away! - there will be replies from people with very good Medicaid knowledge who can help.
Not sure if I can help. Have filed for Medicaid for my Mom to cover her care in a NH. Have a disabled nephew that I handle his Medicaid for health insurance only.
What is reason code 7 and what are u filing for LTC or Medicaid health insurance?
A: 7 Third Party Processing Delay - must be submitted within 30 days from the time submission came within the control of the Provider.
From this I infer that the OP explained to Medicaid that the delay in submitting the claim happened because somebody else - hospital, service provider or whatever - dillied about instead of sending their payment demand over promptly. Or because some other crucial information was missing and had to be dug up from a basement in Kalamazoo. Whatever.
For this to be a valid and acceptable explanation, the claimant would have to have submitted the delayed claim within thirty days of having the 'submission' under his control.
But suppose you, an innocent family member, find out that your Aunty Flo has been in rehab for weeks, go to see her out of the kindness of your heart, and when you get there find she's in a complete muddle about what's going on and promise to go to her house. And suppose that at her house you find a reminder about an outstanding bill from the hospital, but you can't find the original and Aunty hasn't a clue, and you very kindly offer to assist her. It then takes you six weeks to track down copies of original documents. So the claim is older than ninety days, and it's taken you more than thirty days to solve it even once you became aware of it; but there are good reasons for that.
So the thing to have done, then, would have been to contact Medicaid about the potential claim immediately but explain that the claim could not be submitted until you obtained the documents and ask for an extension. If you waited until you got everything together... you've missed your four week deadline.
Or it could just be that the form is ambiguous about what date exactly they're asking about in what particular box, and it'll be a comparatively simple correction rather than any high-agility arguing that you'll need to do.
But in any case - I should ring them up and ask them. Could you by any human effort have got the claim into them within thirty days of having taken charge of it? Did you in fact meet that deadline? Keep arguing, and good luck!
Have you tried looking for a helpline number on your area's Medicaid website? If you can speak to a human being, I've always found that's the quickest way to discover where you're going wrong when you're filling out a form. It's often the case that these things are simple - when you know how.
I feel for you and for all Americans trying to find their way through the Medicaid maze. I have been on this forum for, gosh, five years? and tried to educate myself about how it's all supposed to work, and I have to say that sometimes I wonder how anyone in the US ever does manage to sort out their healthcare.
Would you like to say what the background to your claim is? - just in case that might shed any light on what the problem might be.
Many people on the forum have relied on professionals to help them with the medicaid application process, the social worker at a facility or an elder law/medicaid attorney. If the alternative is being denied then I think that it is money well spent.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
What is reason code 7 and what are u filing for LTC or Medicaid health insurance?
Q: Code 7 is what, pray?
A: 7 Third Party Processing Delay - must be submitted within 30 days from the time submission came within the control of the Provider.
From this I infer that the OP explained to Medicaid that the delay in submitting the claim happened because somebody else - hospital, service provider or whatever - dillied about instead of sending their payment demand over promptly. Or because some other crucial information was missing and had to be dug up from a basement in Kalamazoo. Whatever.
For this to be a valid and acceptable explanation, the claimant would have to have submitted the delayed claim within thirty days of having the 'submission' under his control.
But suppose you, an innocent family member, find out that your Aunty Flo has been in rehab for weeks, go to see her out of the kindness of your heart, and when you get there find she's in a complete muddle about what's going on and promise to go to her house. And suppose that at her house you find a reminder about an outstanding bill from the hospital, but you can't find the original and Aunty hasn't a clue, and you very kindly offer to assist her. It then takes you six weeks to track down copies of original documents. So the claim is older than ninety days, and it's taken you more than thirty days to solve it even once you became aware of it; but there are good reasons for that.
So the thing to have done, then, would have been to contact Medicaid about the potential claim immediately but explain that the claim could not be submitted until you obtained the documents and ask for an extension. If you waited until you got everything together... you've missed your four week deadline.
Or it could just be that the form is ambiguous about what date exactly they're asking about in what particular box, and it'll be a comparatively simple correction rather than any high-agility arguing that you'll need to do.
But in any case - I should ring them up and ask them. Could you by any human effort have got the claim into them within thirty days of having taken charge of it? Did you in fact meet that deadline? Keep arguing, and good luck!
I feel for you and for all Americans trying to find their way through the Medicaid maze. I have been on this forum for, gosh, five years? and tried to educate myself about how it's all supposed to work, and I have to say that sometimes I wonder how anyone in the US ever does manage to sort out their healthcare.
Would you like to say what the background to your claim is? - just in case that might shed any light on what the problem might be.