Claims for Medicare Advantage patients top WPS mental health denials
WPS is the Medicare contractor for six Midwest states. Check each patient's plan before the visit, and bill the Advantage plan.
Co-founder, JotPsych
Your Medicare patient joined a Medicare Advantage plan, and your claim still went to original Medicare. Medicare denies your claim.
WPS Government Services, “Mental Health Playbook: Psychiatrist Common Rejections and Denials,” April 8, 2026, 60 minutes. https://www.youtube.com/watch?v=kt5r97nkRlk
WPS Government Services processes Medicare claims for Iowa, Kansas, Missouri, Nebraska, Indiana, and Michigan. The educator ranks the reasons WPS rejected and denied psychiatrists' claims, and explains how to prevent the top denial.
Among psychiatrists' claims sent from December 1, 2025, to February 28, 2026, WPS denied most often because the patient had an Advantage plan, a WPS educator says at 27:00.
- Ask to see every card at every visit. Ask whether anything changed, and whether your patient has more than one card, the WPS educator says at 45:00. Your patients can switch plans each fall, and new plans start January 1.
- Run an eligibility check before the visit. The check shows whether your patient has original Medicare or an Advantage plan, an educator says in a second WPS video at 32:30.
- Bill the Advantage plan, not original Medicare. Whatever your state, your Medicare contractor processes claims for original Medicare only. WPS can't answer questions on Advantage claims either, the educator in the first video says at 27:30.
- Check a claim's status before you send it again. Your billing service may resend every unpaid claim after 30 days, and WPS calls that resending abuse when nobody checks the status first (46:00). Ask your billing service how it handles unpaid claims.
Medicare Advantage also topped WPS's denials of counselors' claims sent from February 1 to April 30, 2026, the second video shows at 19:30.
Medicare.gov lists these dates, and Advantage patients can change plans in both enrollment periods. A card you saw in the fall can be out of date by spring.
Our view
When the card and the eligibility check don't match, trust the check. Your patients may keep an old card. The check shows the plan Medicare has on file for the visit date.
JotPsych's eligibility worklist checks this week's visits in one run and holds any Medicare Advantage notice for review.
Book 15 minutes- WPS Government Services, "Mental Health Playbook: Psychiatrist Common Rejections and Denials," YouTube, April 8, 2026, 60 minutes. A WPS webinar held April 2, 2026, on Part B claims from psychiatrists in Jurisdictions 5 and 8, submitted December 1, 2025, to February 28, 2026.
- WPS Government Services, "Mental Health Playbook: Mental Health Counselor Common Rejections and Denials," YouTube, June 24, 2026, 50 minutes. A WPS webinar held June 11, 2026, on claims from mental health counselors submitted February 1 to April 30, 2026.
- Centers for Medicare & Medicaid Services, "What's a MAC", page modified July 8, 2026: a Medicare Administrative Contractor (MAC) processes Part A and Part B claims for Medicare fee-for-service patients, the patients of original Medicare. Read October 5, 2026.
- Medicare.gov, "Joining a plan": Open Enrollment, October 15, 2026, to December 7, 2026, with coverage from January 1, 2027; Medicare Advantage Open Enrollment, January 1, 2027, to March 31, 2027. Read October 4, 2026.