Wiki Corrected Claim VS Voiding claim: What would you do??

[CBR11]

Hoping to get some feedback on an issue I am having with submitting corrected claims.

The scenario:
Physician office files a claim to Medicaid MMA and after claim is submitted a commercial insurance is discovered that the patient had not reported to either Medicaid or our office. Our office reports the commercial insurance to the MMA and files a claim to the commercial insurance.

In the meantime the MMA pays claims and then the commercial insurance pays claim, now the claim is overpaid.

I have been resubmitting the claim to the MMA as a corrected claim with a copy of the EOB from the commercial insurance. My thought is that the MMA will see the commercial insurance payment and reprocess their claim and ask for a refund of the overpayment.

What is routinely happening is the MMA’s are denying as a duplicate when the claim is clearly marked with a submission code 7 with the claim # references.

My other option would be to submit a voided claim but I feel this is not correct as the service was provided so I do not feel the void would be appropriate.

This is a huge problem for our office. Patients routinely do not disclose their commercial insurance as they do not want to pay “ANYTHING” and think that if they don’t disclose they commercial insurance will not be eventually discovered.

How would you handle the overpayments on the claim?

 

[thomas7331]

From what you've described, it appears to me that the errors here are on the part of the Medicaid payer and not yours as it is clear that the plan is overpaying the claim in spite of being notified by you of the error. The only thing I would recommend is to verify, if you haven't done so already, that you are following the plan policy for how to submit corrections or get the claims adjusted to be paid correctly. If you are already following the payer's procedures correctly, then I would not advise trying to find a workaround to fix their mistakes as this could end up causing you more headaches down the road. If they continue to make payment errors even when given the proper information that they need to pay the claim correctly, then my next step would be to escalate the issue with a supervisor or network representative in some position of authority. If that fails, then since this is Medicaid and the payer is mishandling taxpayer money, you can contact one of your state government representatives and alert them to this situation because if this is happening to you, it is likely happening to other providers, and many may not be as concerned as you are about getting that money returned. I suggesting finding out which representatives are on the committee that oversees the Medicaid plan, and notify them in writing. I've done successfully in the past, and especially when it is close to an election, the representatives are likely to be very responsive and wanting to ensure that they are acting in their constituents' best interests. State budgets are tight and no official wants it to become known that money is being wasted due to poor oversight or failures to follow proper procedures.