Wiki Medicaid and deductibles/denials?

[mitzfritz215]

When Medicare applies the charges to the patient's deductible and Medicaid either pays a portion or denies it do I write off the balance after Medicaid paid their portion or denied it?

If Medicaid denies any claim after Medicare has paid their portion am I supposed to write off the balance? I've been writing off the balance when it reads "did not pay on the charge" but I'm not sure if I should be writing off the balance when it reads "denial".

Should everything be written off when the patient has both Medicare and Medicaid and there's a balance due?

If the patient did not meet eligibility for Medicaid wouldn't they owe the balance due?

I've very confused on what I'm supposed to write off.

 

[Herbie Lorona]

If they denied the claim I wouldn't just write the balance off. First you would want the reason why they are denying the claim. If you can please provide more info and we could help you out more with this. If you like you can email me.

 

[MarcusM]

Medicaid Medicare

Medicaid pays up to their maximum allowable so Medicare may have paid more than the Medicaid allowable but it should not be noted as "denied".

 

[dclark7]

You need to determine the reason for the denial. All insurance companies including Medicaid must provide a denial code and the reason. As MarcusM stated Medicare may pay more than Medicaid allows, in that case you would adjust off the balance. If a patient did not meet eligibility requirements then he/she would be responsible for the balance. Again, the EOB should state that the patient was not eligible for that date of service.

Check your EOBs for denial codes, if you're still not sure then call your provider rep and ask for help in understanding the denials.