bethb
Guru
Good afternoon!
Anyone out there from the state of North Carolina? I am having trouble finding clear answers regarding primary insurance and secondary Medicaid billing. I also work on billing for Pennsylvania providers and have a firm grip on Pennsylvania's rules with regard to Medicaid secondary claims. Having trouble with NC, though.
Anways, if a patient has a Blue Cross/Blue Shield primary insurance (or any non-Medicare plan-i.e. commerical-Cigna) with a $35.00 co-pay (patient does not pay co-pay at time of service) and BCBS pays at their allowable amounts (provider is in-network with BCBS and Medicaid) and the balance left is the co-pay, does Medicaid have any responsibility to pay the co-pay amount? I've talked to several representatives at Medicaid in NC and have been told that Medicaid (in NC) will consider deductible / co-insurance balances after a primary insurance pays but has no responsibility to pay co-pay balances.
If Medicaid has no responsibility to primary insurance co-pay balances, then is the patient liable for the co-pay amount or is it an adjustment?
Co-pays are in the member's contract but what happens if the member has Medicaid as their secondary?
Anyone have any insight?
Thank you in advance for your time!
Beth![Confused :confused: :confused:](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Anyone out there from the state of North Carolina? I am having trouble finding clear answers regarding primary insurance and secondary Medicaid billing. I also work on billing for Pennsylvania providers and have a firm grip on Pennsylvania's rules with regard to Medicaid secondary claims. Having trouble with NC, though.
Anways, if a patient has a Blue Cross/Blue Shield primary insurance (or any non-Medicare plan-i.e. commerical-Cigna) with a $35.00 co-pay (patient does not pay co-pay at time of service) and BCBS pays at their allowable amounts (provider is in-network with BCBS and Medicaid) and the balance left is the co-pay, does Medicaid have any responsibility to pay the co-pay amount? I've talked to several representatives at Medicaid in NC and have been told that Medicaid (in NC) will consider deductible / co-insurance balances after a primary insurance pays but has no responsibility to pay co-pay balances.
If Medicaid has no responsibility to primary insurance co-pay balances, then is the patient liable for the co-pay amount or is it an adjustment?
Co-pays are in the member's contract but what happens if the member has Medicaid as their secondary?
Anyone have any insight?
Thank you in advance for your time!
Beth