Wiki How to bill and post payments to Dual plans?

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torresangbabs

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Hi,
Just want to know if anyone knows about these dual plans. As I understood the dual plans replace Medicare and Medicaid QMB recipents. And we are to only bill the dual plan. And since there is no secondary it's accepted as full payment? Because we can not balance bill Medicaid. Please give me feed back on this?
 
It's been my experience that we receive two payments, if they actually cover anything under the Medicaid portion. Usually, we get a single payment with the balance being a contractual adjustment. The EOB is pretty clear if there is any patient responsibility. Since the "secondary" is the Medicaid component, there is usually no "secondary" payment because the MA payment is more than what we would have received from traditional Medicare + Medicaid...or so they tell us anyway.
 
Dual plans are simply Medicare primary plus Medicaid is the secondary, if the patient has met their yearly deductible there usually is no secondary payment. If the patient hasn't met their deductible there will be a secondary payment from the Medicaid portion of the plan. Also with Medicaid as a secondary to any plan if the primary allowable amount is higher than the Medicaid allowable amount and the plan deductible has been met there will be no secondary Medicaid payment, you will need to adjust that off.
 
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