Pediatric Coding Alert

Question: We are not listed with the Medicaid system in our state as a participating Medicaid provider, but we do choose to see Medicaid patients on a case-by-case basis (for instance, if a longtime patient moves to Medicaid from a private plan). However, we are having some issues getting Medicaid to put us on record as the primary care provider. Can you provide any advice for how to make this happen in a timely manner?

Arkansas Subscriber

Answer: Medicaid rules vary by state, but in most cases, your patient's parents will have to get a form from their Medicaid caseworker. As the pediatrician, you'll have to fill out your portion of the form and sign it so it can be submitted to Medicaid and you can get on record as the primary care physician of record.

In some cases, the patient's parents won't take care of the form, or the caseworker will say it isn't required, or your form can fall through the cracks once it makes its way to the state Medicaid office. In those cases, you might consider calling Medicaid to find out who the prior primary care physician was, and then call that physician for approval to see the patient (which will require you to get that physician's NPI number). During this process, you should have a frank conversation with the patient's parents to ensure that all forms are completed properly and that you, the caseworker, and the parents are workingtogether to get you assigned as the Medicaid primary care provider as soon as possible.