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Child with Medicare and Medicaid

Messages
147
Location
Anchorage, Alaska
Best answers
0
One of my providers is a psychiatrist who sees only pediatrics. Therefore, he is not enrolled with Medicare. However, he has a patient who we thought only had Medicaid, but it turns out has Medicare as well. Since the provider is not enrolled with Medicare, we cannot bill Medicare to get a denial, and Medicaid will not process the claim without the Medicare denial. How do other pediatric providers handle this situation?

Thank you in advance,
Karen:confused::confused:
 

CodingKing

True Blue
Messages
3,955
Best answers
1
I believe the minimum age for Medicare is 18 (under disability coverage) so i'm not sure how a child has Medicare. I assume you meant "adult child"?
 
Messages
147
Location
Anchorage, Alaska
Best answers
0
I believe the minimum age for Medicare is 18 (under disability coverage) so i'm not sure how a child has Medicare. I assume you meant "adult child"?
There is no minimum age for Medicare for a person who qualifies due to ESRD. So, no I did not mean an "adult child". This provider sees only pediatric patients.
 
Last edited:

michellepilcher

Networker
Messages
88
Location
Anchorage , AK
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0
This is what I've found which may or may not pertain to the situation:
Nonparticipating Providers and Suppliers:

*May accept assignment of Medicare claims on a claim-by-claim basis;

*Receive lower PFS allowances than participating providers and suppliers for assigned or
nonassigned claims;

*May not submit charges for nonassigned claims that are in excess of the limiting charge amount (with the
exception of pharmaceuticals, equipment, and supplies). Nonparticipating providers and suppliers may
collect up to the limiting charge amount at the time services are furnished, which is the maximum you can
charge for the services furnished (unless prohibited by an applicable State law); and

*Are not included in the MEDPARD

Here is the link to the PDF:
https://www.cms.gov/Outreach-and-Ed...dicareClaimSubmissionGuidelines-ICN906764.pdf

Michelle
 
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