Otolaryngology Coding Alert

Question: How do we correctly submit claims when Medicaid is the secondary insurance?

Virginia Subscriber

Answer: When you submit a secondary Medicaid claim and it did not automatically cross over to Medicaid from the primary, type or write "TPL" and the amount of the primary payment (with no spaces in between) in the red-shaded block of the CMS1500 form. For example, insert TPL24.50 for a primary payment of $24.50. Be sure the text is left justified in the block. If you're inserting a line item for a vaccine, type or write TPL12.00 NDC999999999.

Remember: Each state could be different, so you need to know your local guidelines. For example, if a patient in Kentucky has Medicaid as the secondary carrier, Medicaid won't pay anything if the primary insurance has already paid as much or more than the Medicaid allowable. You cannot bill the patient for an unpaid co-pay or deductible once you bill Medicaid, so keep that in mind when setting your office policies.