Medicare Bypass

[pajohnson]

Hello all,
I have a client who is wanting us to bypass Medicare primary and have secondary Medicaid pay for her claims. I was told to put the verbiage "provider not approved to bill services to Medicare" in box 19. Has anyone else ever done this? I have not and just want to be sure this is correct. Any feedback is greatly appreciated!!

 

[sls314]

Hello all,
I have a client who is wanting us to bypass Medicare primary and have secondary Medicaid pay for her claims. I was told to put the verbiage "provider not approved to bill services to Medicare" in box 19. Has anyone else ever done this? I have not and just want to be sure this is correct. Any feedback is greatly appreciated!!

Is this for a behavioral health provider that falls under the exception stated in the Indiana Medicaid provider booklet Third-Party Liability: Coordination of Medicaid Benefits With Other Insurance, Including Medicare?

If they are, follow the instructions listed in the booklet under the section Billing and Reimbursement for Dually Eligible(Medicare/Medicaid) Members. It starts on page 20-21 at the link, and I've included an excerpt in the screenshot below as well.

https://www.in.gov/medicaid/providers/files/modules/third-party-liability.pdf

If your provider doesn't fall under the behavioral health exception, then you should refer them to a provider that is enrolled in both Medicare and Medicaid. (As stated in the booklet, and also captured in the screenshot above.)

 

[ckeeney]

Hello all,
I have a client who is wanting us to bypass Medicare primary and have secondary Medicaid pay for her claims. I was told to put the verbiage "provider not approved to bill services to Medicare" in box 19. Has anyone else ever done this? I have not and just want to be sure this is correct. Any feedback is greatly appreciated!!

I work for a behavioral health facility in Indiana and the only instance where we do not bill Medicare is as noted for the dually eligible clients where our providers are not eligible providers for credentialing with Medicare. These are mostly therapists. In those instance we do add a note as stated in Susan's reply with the manual. I am not sure that a client can specify not billing Medicare primary.

 

[pajohnson]

Thank you all for your responses! This is for behavioral Health and we are located in Indiana. The therapist that she saw is not credentialed with Medicare, but is with the patient's secondary Medicaid. Is this a situation where I would use the provider note?
I just want to make sure that I am understanding this correctly.
Thanks again for your help!!!