Wiki Medicaid Guidelines on Reimbursement


Omaha, NE
Best answers
I'm a physician based coder for a resident clinic and my experience has been hospital coding. Now I'm in a bind of trusting the information my training partner and looking for other resources of understanding the reimbursement guidelines for medicaid and their subcategories of providers (Coventry, Share Advantage, Medicaid NE or now UHC Community Plan) I'm a Nebraska resident and understand states have different guidelines but the questions I ask for clarity are:

1) Routine Health Maintenance Physicals are not covered for men over 18 yrs under these plans? Why?

2) What types of immunizations are covered for adults under the medicaid plan? (Hepatitis A, Influenza (understand the guidelines) TD, etc.)

3) What is considered a bundle service?

I'm really asking for more helpful resources to better understand my thought process and helping my clinic retain the information as well. It's been a fustrating 3 months being in this new position and no work processes are in order or manual for information when you have employees who have been doing this for 12-20 years and are not being informative. I want to achieve and excell with my knowledge base of physician based coding. I appreciate any information.

Fustrated Coder!