Wiki Medicaid Confusion

[mzshawnda2u]

Could someone please help me??!!! I need help interpreting Medicaid (Florida) EOB's. They take forever to pay and finally when they do send the EOB it looks as if we have to write everything off. We only have a couple Medicaid patients but alot of patients have Medicaid as a secondary. Is there a site I can go on specifically for Medicaid? Why don't they pay for services????

 

[mitchellde]

Medicaid is different in every state and if you are a Medicaid provider for Florida then they should have provided you with a resource for information, whether that is a website or phone number. However I did find in one state the reason a provider was not being paid was they were using the wrong place of service. The physician was seeing Medicaid HMO patients in the outpatient setting and the billing service was using place of service 11. So while the hospital was a covered entity the physician was not as long they were using 11 for place of service, when they changed to the correct POS of 22 he was paid fine. My point being there may be something like this that is incorrectly entered on the claim, it only takes one little thing for Mediciad to turn the entire claim back as unpaid.

 

[flacoder2001]

Hi R'Shawnda,

I have been billing Fla Medicaid for 23 years. It is frustrating to say the least, but you can do it. One of the stipulations of being a Medicaid provider is that you cannot balance bill the patient. That means you accept what Medicaid pays and write off the rest. If you bill Medicaid as secondary you still have to write off the amount when Medicaid denies the claim as secondary which is 90% of the time. Medicare patients are mostly the ones who have Medicaid as secondary and if you put the Medicaid secondary info on the claim it will crossover, but mostly likely deny because Medicare has already paid more than what Medicaid would and you must write off that amount, it is part of your Provider agreement. If you bill claims electronically you get paid within 7 days.
You must imput the claims before 11:59pm on Wednesday and you will be paid the next week by Friday, and if you have EFT you get paid even faster.

Go to:http://portal.flmmis.com/FLPublic/Provider_Home/tabId/36/Default.aspx

and there you will find Provider information, resources and help. On the left in the box for Provider click on EDI then Submission and look for the secure web portal link. You will have to call Medicaid and get a sign on and password but from there you can submit your claims electronically and print your remittance advices.

I hope this helps you.

 

[mzshawnda2u]

ThankYou both for the info...I am gonna checkout that website to see if it can offer anymore assistance. The problem is we don't accept Medicaid. There are only two patients we have that currently have Medicaid, they are special cases and both have several outstanding claims dating back to 7/08. The others are mostly secondary to Medicare. We do accept Medicare but since we are not Medicaid providers can we Balance Bill patients????

 

[flacoder2001]

ThankYou both for the info...I am gonna checkout that website to see if it can offer anymore assistance. The problem is we don't accept Medicaid. There are only two patients we have that currently have Medicaid, they are special cases and both have several outstanding claims dating back to 7/08. The others are mostly secondary to Medicare. We do accept Medicare but since we are not Medicaid providers can we Balance Bill patients????

since we are not Medicaid providers can we Balance Bill patients????

If you are not a Medicaid provider you cannot bill or get paid by Medicaid.
How did you bill and receive an EOB if you are not a provider? You need a provider number to bill and receive payment.

If you are not a Medicaid provider, the answer is easy, bill the patient.

 

[mitchellde]

I agree if you are not a Medicaid provider how is it that the visit occurred? Was the patient informed that you were not a Medicaid provider or did they become Medicaid after the encounter. What does the EOB from Medicaid say? If the patient was informed then I say bill the patient!