Hello,
We have been having problems with our billing system where MEDICAID claims are paying to the member's PCP, not the rendering provider. Before going to the manufacturer to get changes to our billing system, is this a Medicaid or CMS rule/regulation? I have searched their website through and could not find any regulations on if they pay per the member's contracted PCP or to the rendering provider. Or if there is a problem with our billing system.
Ex: Member's PCP is a Physician Assistant, but goes and sees an MD for services at the same group. Claim pays per the PA rate instead of the MD rate, which is lower than what the MD was expecting to get paid.
We have been having problems with our billing system where MEDICAID claims are paying to the member's PCP, not the rendering provider. Before going to the manufacturer to get changes to our billing system, is this a Medicaid or CMS rule/regulation? I have searched their website through and could not find any regulations on if they pay per the member's contracted PCP or to the rendering provider. Or if there is a problem with our billing system.
Ex: Member's PCP is a Physician Assistant, but goes and sees an MD for services at the same group. Claim pays per the PA rate instead of the MD rate, which is lower than what the MD was expecting to get paid.