PMAP vs MA Reimbursement

ejallo 4 years ago in Codes/Rates/Diagnosis Modules updated by sarah 4 years ago 1

Does anyone know why some PMAPs pay different rates from MA for the same service/provider? 

It seems like they should be the same since the PMAPs follow MA guidelines. 


Some take out the 2% tax, but some (BluePlus would be our most recent 'under-payer') just pay less. We are currently fighting with BluePlus regarding their ITFC reimbursement. It is over $100 less than the DHS guidelines. And you are only able to go through secure email with them, when it is more than 10 DOS. Since clients are generally seen more than once per week under ITFC, the DOS paid on one ERA can be well over 10.