Wiki Medicaid Secondary

[chavera]

Hello,

I was wondering if anyone has an answer to my question about billing Medicaid secondary. We have several patients who have Medicare and Medicaid and when Medicare pays we send the remaining balance to Medicaid. I was not sure if we could bypass billing Medicare and just adjust the balance off since Medicaid never pays?

Thank you

 

[AprilSueMadison]

I don't know if this is the norm, but that is what we do. We are not contracted with the local Medicaid plan, so we've called them before and have been informed there is nothing we can do. They won't pay as secondary, and denials take AGES. We just write them off.

 

[crollins]

Medicaid pay up their allowable, so if Medicare pay $95 for ov and Medicaid allowable is less than,we adj off as contractual allowance

 

[Stacy1996]

yes, Medicaid only pay up to their allowable and if we know that primary pays more, then we will adjust the bill, but sometime we send it through to get the denial.

 

[lapcpc]

I would check with your State Medicaid. As I was told before that I need to send the secondary claim to Medicaid, even if they do not pay, it is part of their guidelines if you are in-network with them.

 

[mrsjehu]

We bill it even if we know it will be non covered. Sometimes I bill it and then immediately make the adjustment on ones that I know will not receive any additional reimbursement.

 

[MarcusM]

This is a dilemma for providers as it takes time to bill Medicaid as secondary. Our MAC auto adjudicates to secondary payers, or it is supposed to do this if it has the correct information. Medicaid processes these claims for data mining to track and report to Uncle Sam. I managed a pediatric practice and the Texas Medicaid Manual instructed all providers to bill vaccines with an administrative fee of $5.00 as that was what Medicaid allowed. Fast forward a couple of years, and I was discussing this low reimbursement with one of the Regional Directors. He said they paid this $5.00 as that was the usual and customary amount billed by providers in Texas. He was not aware of the mandated $5.00 allowable and was data mining in the State of Texas using this $5.00. When I was able to show him what commercial carriers were paying at that time, $11.00-$13.00, he was quite surprised. It took quite awhile, but this fee was later raised.