Wiki Non Par Provider with Medicaid

[ninaogh]

Hi

I am in the New York area however we do not participate with Medicaid or Medicaid Managed Care, what are the policies and requirements when billing these patients.

Thanks

 

[csperoni]

https://www.health.ny.gov/health_care/medicaid/program/update/2014/2014-02.htm

If you are non-par with all Medicaid and Medicaid managed care, you should inform the patient that you are out of network. The patient has the option to see you as a cash patient, or seek care from an in network provider. As advised in the link:
A provider who does not participate in Medicaid fee-for-service, but who has a contract with one or more managed care plans to serve Medicaid managed care or FHPlus members, may not bill Medicaid fee-for-service for any services. Nor may any provider bill a beneficiary for services that are covered by the beneficiary's Medicaid managed care or FHPlus contract, unless there is prior agreement with the beneficiary that they are being seen as a private pay patient as described previously. The provider must inform the beneficiary that the services may be obtained at no cost from a provider that participates in the beneficiary's managed care plan.
I suggest creating a form for the patient to sign stating this prior to any services.

 

[AuditU]

Hi! I need clarification if this is also true for Florida - I am currently working on an independent project and their website is horrible and I have been on hold for over 30 minutes trying to get an answer.

I did find this is one of the manuals


Thank you!