OB Billing..HELP!

aklunder

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We are running into issues when patients have Medicaid secondary. We typically bill according to the primary insurance, which is normally billed out globally, which Medicaid would be billed ala carte. However we have run into issues where when we bill the claim out, the entire charge is applied to the patients deductible, the patient is not eligible for the primary insurance at the end of the pregnancy, or decides to see another provider towards the end of the pregnancy. The problem arises as we can run into filing limits, which will cause Medicaid to deny the claim. Does anybody have any suggestions on how we should bill for patients with Medicaid secondary? Do we have to bill globally?
 

ajs

True Blue
Local Chapter Officer
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Tacoma, WA
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We are running into issues when patients have Medicaid secondary. We typically bill according to the primary insurance, which is normally billed out globally, which Medicaid would be billed ala carte. However we have run into issues where when we bill the claim out, the entire charge is applied to the patients deductible, the patient is not eligible for the primary insurance at the end of the pregnancy, or decides to see another provider towards the end of the pregnancy. The problem arises as we can run into filing limits, which will cause Medicaid to deny the claim. Does anybody have any suggestions on how we should bill for patients with Medicaid secondary? Do we have to bill globally?
Most Medicaid plans will accept global billing if the patient was eligible on Medicaid for the entire pregnancy. If not, you will have to break out the billing according to their guidelines and bill it with a copy of the EOB from the primary. You may have to appeal if you get denied.
 
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