Wiki Commercial Insurance and Medicaid

[cedwards641]

I have been told by the pediatric manager that when a child comes in for a wellness check (where they usually receive vaccines) that Medicaid or CMO insurance is billed as PRIMARY and the commercial insurance is SECONDARY. I don't believe this to be true, does anyone know if there is an exception to the rule that "medicaid is always the payer of last resort" and where can I find this if it exists. She wants to bill medicaid as primary when they come in for wellness/vfc vaccines and bill commercial when it's a sick visit.

 

[thomas7331]

I have never heard of this exception, and think it is highly unlikely now that commercial plans are required to include preventive care benefits - there would be no reason for the Medicaid plans to cover this as a primary payer. If there is such an exception, you should be able to find out from your Medicaid contractor or your state's Medicaid program manual. But my expectation would be that if Medicaid has a record of the patient having other insurance and you submitted this to Medicaid first, it would be denied for the primary carrier's EOB.