Wiki Medicaid

[staceylw31@aol.com]

Has anyone run into this issue....we have patients that will come in and not tell us that they have primary insurance. Medicaid will find out and retract the money they paid and then tell us to submit claim to primary. HOWEVER, When we I do this, the claim rejects for DUPLICATE because Medicaid submitted their own claim and were PAID as though they are us and then they are keeping the money paid. When I send a request to them to pay us that money because they are NOT the patients primary provider, they send us less then what they were paid. I feel they should be sending us the full amount PLUS whatever is due as secondary, but of course I feel as though this is just wrong all together. Any thoughts??

Stacey

 

[thomas7331]

Has anyone run into this issue....we have patients that will come in and not tell us that they have primary insurance. Medicaid will find out and retract the money they paid and then tell us to submit claim to primary. HOWEVER, When we I do this, the claim rejects for DUPLICATE because Medicaid submitted their own claim and were PAID as though they are us and then they are keeping the money paid. When I send a request to them to pay us that money because they are NOT the patients primary provider, they send us less then what they were paid. I feel they should be sending us the full amount PLUS whatever is due as secondary, but of course I feel as though this is just wrong all together. Any thoughts??

Stacey

Medicaid should not be both recovering their payment from the provider and also seeking reimbursement the primary payer. That's essentially 'double dipping' because they're recovering their payment twice. This may resolve itself at some point because it's going to be creating credit balances on the state's accounts, but it may take a lot of time as you're often dealing with a large bureaucracy.

If it's an ongoing issue that's costing your provider a considerable amount of money, I think you'll need to escalate this with them and try to get a resolution. Medicaid plans are notoriously difficult to deal with, but I don't know that you have any choice here but to do just that. However you do have one advantage in that Medicaid is accountable to the state government, so if you are unable to get them to cooperate, you can contact the office of your state senator or representative and ask them to advocate on your behalf in getting the issue addressed.

 

[staceylw31@aol.com]

Medicaid should not be both recovering their payment from the provider and also seeking reimbursement the primary payer. That's essentially 'double dipping' because they're recovering their payment twice. This may resolve itself at some point because it's going to be creating credit balances on the state's accounts, but it may take a lot of time as you're often dealing with a large bureaucracy.

If it's an ongoing issue that's costing your provider a considerable amount of money, I think you'll need to escalate this with them and try to get a resolution. Medicaid plans are notoriously difficult to deal with, but I don't know that you have any choice here but to do just that. However you do have one advantage in that Medicaid is accountable to the state government, so if you are unable to get them to cooperate, you can contact the office of your state senator or representative and ask them to advocate on your behalf in getting the issue addressed.

Thank you for the reply! I am in Delaware and this is becoming a huge issue. When I make them aware of this, the reps say oh we weren't paid because we can't submit a claim. Our insurance commissioner does not deal with any Medicaid plans, only private insurances so do I contact the actual state Rep? I do not feel as though they should be allowed to submit claims to ANY private insurance company and it should be the providers job to do that.

 

[thomas7331]

Thank you for the reply! I am in Delaware and this is becoming a huge issue. When I make them aware of this, the reps say oh we weren't paid because we can't submit a claim. Our insurance commissioner does not deal with any Medicaid plans, only private insurances so do I contact the actual state Rep? I do not feel as though they should be allowed to submit claims to ANY private insurance company and it should be the providers job to do that.

Medicaid plans do sometimes bill directly to the payers to recover amounts that should have covered by the primary plan, but in those cases they should not be recovering from the providers as well. And yes, your insurance commissioner won't be involved in anything regarding Medicaid - their responsibility is primarily to oversee companies that operate and sell commercial policies within the state.

I wouldn't listen to what the Medicaid phone reps say - definitely insist on having a supervisor or manager work on this for you. But if you've escalated as far as you can with Medicaid, then yes, I would get in touch with a state rep or senator. If you can find out which reps sit on the committees that are responsible for overseeing Medicaid, they're probably in the best position to help you, but if not you can just contact whoever represents your area. It might be helpful to see if one of your providers or practice owners knows a representative personally and can use that connection to contact them directly. And this is an election year too, so your timing is good to get a quick response now as they are usually eager to show that they're doing their jobs!

 

[OpenClaims]

Has anyone run into this issue....we have patients that will come in and not tell us that they have primary insurance. Medicaid will find out and retract the money they paid and then tell us to submit claim to primary. HOWEVER, When we I do this, the claim rejects for DUPLICATE because Medicaid submitted their own claim and were PAID as though they are us and then they are keeping the money paid. When I send a request to them to pay us that money because they are NOT the patients primary provider, they send us less then what they were paid. I feel they should be sending us the full amount PLUS whatever is due as secondary, but of course I feel as though this is just wrong all together. Any thoughts??

Stacey

One question I have for you is, when you find out they have Medicaid and you are running their insurance verification eligibility for billing, are you seeing on their Medicaid eligibility that they have a primary insurance? If Medicaid is aware of primary, why is it not listed as secondary on verification site? This information is extremely helpful. Usually it says "Medicaid secondary to xxxx" on the insurance verification forms. Once you have this information, you can contact the patient for additional information on primary and bill accordingly. Or, if it says insurance name, you can take this information to the primary insurance to verify before billing and running into this problem.
If this seems to be a problem within your state, maybe there is team with Medicaid you can work with to remedy why the primary is NOT being listed on the verification site.

 

[staceylw31@aol.com]

One question I have for you is, when you find out they have Medicaid and you are running their insurance verification eligibility for billing, are you seeing on their Medicaid eligibility that they have a primary insurance? If Medicaid is aware of primary, why is it not listed as secondary on verification site? This information is extremely helpful. Usually it says "Medicaid secondary to xxxx" on the insurance verification forms. Once you have this information, you can contact the patient for additional information on primary and bill accordingly. Or, if it says insurance name, you can take this information to the primary insurance to verify before billing and running into this problem.
If this seems to be a problem within your state, maybe there is team with Medicaid you can work with to remedy why the primary is NOT being listed on the verification site.

no it is usually not listed when we see that patient on that date because the patient did not notify them at the time either. Medicaid finds out after the fact by running their own Coordination of Benefits and THEN they retract the claim. It is a huge mess on Medicaid's part.

 

[kerinnejb@icloud.com]

Has anyone run into this issue....we have patients that will come in and not tell us that they have primary insurance. Medicaid will find out and retract the money they paid and then tell us to submit claim to primary. HOWEVER, When we I do this, the claim rejects for DUPLICATE because Medicaid submitted their own claim and were PAID as though they are us and then they are keeping the money paid. When I send a request to them to pay us that money because they are NOT the patients primary provider, they send us less then what they were paid. I feel they should be sending us the full amount PLUS whatever is due as secondary, but of course I feel as though this is just wrong all together. Any thoughts??

Stacey

I‘ve worked Medicaid accounts for years and never experienced them forwarding our claims to the other insurance carrier (maybe that’s your state policy). The process is once you receive that information you bill your claims to the primary carrier. If denied for untimely filing you include the EOB/RAD or letter from Medicaid to support timely filing. If possible try to speak with a manager/supervisor at MediCaid or file a grievance/appeal