Wiki Billing SC Medicaid 2dary

[clemsoncannons@yahoo.com]

I have some questions about SC Medicaid:
If a facility that is out of network for all primary providers. Is it legal to opt out of network to be able to bill Medicaid for everything up to Medicaids allowable regardless of primaries allowable?
Can you bill secondary Medicaid with Payment summary if primary will not send you an rob due to being out of network? Thank you

 

[kimberlyadame]

Here in Texas - Not sure where you are located...... But If the patient has TRADITIONAL Medicaid as secondary (not managed care through Amerigroup, Superior, UnitedHealthcare, etc, etc) then yes. Since you are not contracted "in network" with the primary carrier you can go on the Medicaid website and submit your claim through a portal. There is a section of some questions it has is "other insurance information" in this section you can list the insurance companies name, and provide a "verbal" denial reason and Medicaid will process the claim as primary payer.

If you are not in Texas I would ask your state if they have this access on their state portal.

Hope this helps.

 

[clemsoncannons@yahoo.com]

Thank you