Wiki Medicaid global billing

[k_isabel04]

I have a patient with BCBS as primary and Texas Medicaid as secondary.
If Medicaid does not pay for global billing (59400), how do I file the antepartum visits with out getting denied for past timely filing for the early visits?

 

[ajs]

I have a patient with BCBS as primary and Texas Medicaid as secondary.
If Medicaid does not pay for global billing (59400), how do I file the antepartum visits with out getting denied for past timely filing for the early visits?

The rules may change when they are the secondary payer not the primary payer. I would bill them using the 59400 with the EOB from the primary and wait to see if they deny it. These are tricky situations to figure out. Is there anything in the billing instructions from Texas Medicaid on how to bill when they are secondary? Sometimes they already have addressed this situation. The other thing that comes into play here is, if the primary has already allowed as much, or more than, what Medicaid would have as primary, then you have to write off the difference anyway. That is what happens in Washington State with a lot of the Medicaid secondary claims.

"Texas Medicaid Provider Billing Manual...
Medicaid-eligible clients may not be held responsible for billed charges that are in excess of the TPR(Third Party Resources)
payment for services covered by Texas Medicaid. If the TPR(Third Party Resources) pays less than the Medicaid-allowable
amount for covered services, the provider should submit a claim to TMHP (Texas Medicaid Health Program) for any additional allowable
amount."
4.11.1 Client

 

[amitmhaske2014]

TMHP form

Hi,
i have medicare as primary & medicaid texas as secondary, i have so many claims for secondary payor medicaid texas so each & every tym i need to fill up TMHP MRAN form for secondary submission.