Wiki Ohio Medicaid as secondary biller to global OB

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Hello Everyone,

Does anyone know the answer or know where to find the answer regarding Ohio Medicaid's payment, as a secondary payer, to the global OB codes that have to be billed to the commercial payers?
Ex: We billed 59400 to UHC, who applied a generous amount to the patient's deductible, however no reimbursement was received from Medicaid due to code 23--impact of prior payer.

Thank you
 
Hello Everyone,

Does anyone know the answer or know where to find the answer regarding Ohio Medicaid's payment, as a secondary payer, to the global OB codes that have to be billed to the commercial payers?
Ex: We billed 59400 to UHC, who applied a generous amount to the patient's deductible, however no reimbursement was received from Medicaid due to code 23--impact of prior payer.

Thank you


If Ohio Medicaid were the primary payer, the allowed amount would have been $1,175.28. (That's the 2022 Ohio Medicaid Fee Schedule Rate for CPT 59400.) Ohio Medicaid will not pay any additional money if the primary payment was already equal or more than the Medicaid fee schedule amount.

I know you said there was a substantial amount placed to the patient's deductible. Here's my question - did UHC make an actual payment of at least $1,175.28? If so, you have to write off the balance, because you've already been compensated what Medicaid would have paid if they were primary. No further money will be paid and you can't bill the patient.

If UHC didn't actually pay you anything because they applied it all to the patient's deductible, then you need to get your Medicaid remit corrected. Most likely the coinsurance/deductible amount didn't get show up correctly on the Medicaid claim. You can go into MITS and fix that yourself. No need to rebill a corrected claim.

Resource links:

Ohio Medicaid Fee Schedule: Appendix DD is the one applicable to physician services - you can find it at this link under the heading "Medicine, Surgery, Radiology and Imaging, and Additional Procedures (Non-Institutional Services)"

MITS (Medicaid Information Technology System - this is where you go to look up your Medicaid claims/payments and can make adjustments to your own claims): https://medicaid.ohio.gov/resources-for-providers/mits/mits
 
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