COB

[jjihye0829]

How do you guys handle COB issue with Medicaid patients? We tried to contact patient, but patient does not return any response. Insurance is stating we can't bill Medicaid patients for COB issue.

 

[SharonCollachi]

Which insurance is saying that? Medicaid?

If the patient does not give you the correct insurance information, then in my world it is on them. YMMV.

 

[jjihye0829]

Which insurance is saying that? Medicaid?

If the patient does not give you the correct insurance information, then in my world it is on them. YMMV.

Insurance is Horizon NJ health. Insurance representative was so firm about "DONT BILL MEDICAID PATIENT WITH COB ISSUE".

 

[SharonCollachi]

Insurance is Horizon NJ health. Insurance representative was so firm about "DONT BILL MEDICAID PATIENT WITH COB ISSUE".

Tell them to put it in writing, AND put in writing how they're going to resolve the issue. Doing nothing or making it your financial responsibility is not acceptable.

 

[mflint]

COB issues in Virginia tend to stem from a lack of communication between individual DSS agencies and DMAS. There is quite a bit of turnover and things don't get updated as they should. I can usually get the other coverage ID number from the Medicaid MCO I'm dealing with. Once I have that, I check to see if it's an active coverage. Nine out of ten times it isn't, so I can usually get the MCO to escalate verification on their end. They update it and reprocess the claim. Sometimes its a 30 day delay, but I've had success with it. If I find there is another active coverage we update the claim and bill the primary. Billing Medicaid patients violates our provider agreement if we know for certain the patient is Medicaid eligible, so I don't recommend that at all.

 

[sls314]

How do you guys handle COB issue with Medicaid patients? We tried to contact patient, but patient does not return any response. Insurance is stating we can't bill Medicaid patients for COB issue.

Have they told you which insurance they think is primary?

I often look up the eligibility myself if I know which insurance Medicaid is saying should be primary. Either I find it & confirm that I need to bill that commercial policy, or I can provide proof to Medicaid that the commercial policy termed.

Most of the time I can resolve it without even contacting the patient.