Wiki Alabama Medicaid Secondary

[mah3434]

Does anyone know anything about billing Alabama Medicaid? I've never billed Medicaid before and have some questions.
1. If Medicaid is secondary, to they pay their full fee schedule allowed as secondary to Medicare?
2. Do they follow the same incident-to rules as Palmetto?
3. Tell me the pros/cons of going into the Medicaid network.

Any help is appreciated!

 

[sls314]

Does anyone know anything about billing Alabama Medicaid? I've never billed Medicaid before and have some questions.
1. If Medicaid is secondary, to they pay their full fee schedule allowed as secondary to Medicare?
2. Do they follow the same incident-to rules as Palmetto?
3. Tell me the pros/cons of going into the Medicaid network.

Any help is appreciated!

Medicaid allows up to the fee schedule. If the primary payment already exceeded the Medicaid allowable, no additional payment will be made.

Example:

Medicare allowed $200. Medicare pays $160 and patient coinsurance is $40.

Scenario 1: Medicaid allowable for that service is $120. Provider already reimbursed in excess of the allowed amount - no additional payment is issued by Medicaid. $40 coinsurance is a writeoff.
Scenario 2: Medicaid allowable for that service is $180. Medicaid pays $20 ($180 Medicaid allowable - $160 Medicare payment). Remaining $20 of coinsurance is a writeoff in excess of Medicaid allowable.

I don't have specific information about Alabama Medicaid reimbursement methodologies - each state sets its own policies.

The provider information (including reimbursement rules) for Alabama Medicaid can be found here: https://medicaid.alabama.gov/content/7.0_Providers/