ED Coding and Reimbursement Alert

Question: We are in St. Louis so we credential our providers with Missouri and Illinois Medicaid programs since we are so close to Illinois. We occasionally get patients from other states but our physicians are not credentialed with those out of state Medicaid programs. Does anyone else credential with out of state Medicaid programs? Do you credential all of your providers? Any information would be helpful.

Missouri Subscriber

Answer: You will have to consider your individual situation to make this determination. If you practice in Texarkana or worse, near the intersection of the four corners of Arizona, Utah, Colorado and New Mexico, you might want to enroll in multiple state programs. The same can be true for popular tourist destinations. If you have only one or two out of state Medicaid patients per year, it is probably not worth the cost of completing the enrollment and credentialing paperwork for the payment you would receive.

The requirements for participation can differ by state, with some less burdensome than others. Some state Medicaid plans have a very simplified way to participate for the very infrequent patient. Check the patient's state Medicaid website to see if they give specific direction to out of state providers prior to submitting the claims. Otherwise you might try billing out of state Medicaid plans by submitting the CMS 1500, a W-9 and a letter explaining the patient was traveling out of state and request processing of the claim as an exception.

Keep track of your experience to use should you have additional patients from that state in the future.