Medicaid COB

[gcohen]

One of our Medicaid payors is always denying claims to COB, stating another payer. How do you get this rectified when you cannot reach the member or they do not get it resolved. Do you deny appointments? We cannot bill the member.

 

[sls314]

One of our Medicaid payors is always denying claims to COB, stating another payer. How do you get this rectified when you cannot reach the member or they do not get it resolved. Do you deny appointments? We cannot bill the member.

Does Medicaid indicate which payer is listed as primary?

Ohio Medicaid will accept coordination of benefits (COB) termination updates directly from the provider. If the Medicaid portal lists a commercial insurance as the primary payer, I’ll check Availity or the payer’s website to confirm the coverage status. When I find that the commercial plan has actually termed, I print the termination date and upload it to the Medicaid portal.

Of course, sometimes the commercial plan still shows as active - in that case, I’ll go ahead and submit the claim to them first.

 

[gcohen]

You are able to upload this to the Medicaid Managed Care Portal? I fax this to a dedicated line, but they tell me the state still shows active. Have no idea where they are getting this information from.

 

[Louke]

One of our Medicaid payors is always denying claims to COB, stating another payer. How do you get this rectified when you cannot reach the member or they do not get it resolved. Do you deny appointments? We cannot bill the member.

if Medicaid is listing a primary commercial payer which was termed, but member never updated COB, you can try submitting the claim to the primary payer and get the denial for cov. termination then transfer the claim to medicaid as the"secondary plan" and submit it along with the denial from the primary EOB. Hopefully this will help get Medicaid to update the COB.