Wiki Posting medicaid as secondary payments

[LeanneMeek]

I have a patient who has Humana primary, and Medicaid secondary. The Humana paid at their contracted rate, and the claim was submitted to Medicaid. Medicaid denied stating the "COB payment exceeds Plans maximum allowable". What do I do with the $10 balance that is left? Is this a write off? Thanks!

 

[Herbie Lorona]

Most likely yes it is a write off. Usually the way secondarys are processed is you subtract the primary insurances payment from whatever the secondary would normally allow had they been primary. If they primary paid more then they allow then it is a write off. So for instance.

Primary allows $100.00 and pays $90.00 which leaves a $10.00 copay.
If the secondary only allows $85.00 then you shouldn't get an payment and will write off the $10.00
If the secondary allows $95.00 then you would subtract the primary payment of $90.00 and they should pay $5.00 with the additional $5.00 being written off.

 

[mrsjehu]

Yes its a write off. Humana's allowable was likely higher than Medicaid's. That happens a lot.

 

[Herbie Lorona]

Yes it is likely a write off but it doesn't matter what Humana's allowable is it matters on what there payment amount is.

 

[MarcusM]

Medicaid is payer of last resort and your Medicaid contract states you will accept the Medicaid fee schedule as the contracted maximum allowable for Medicaid patients. If commercial insurance or any other insurance, auto, Medicare, etc pays higher than the Medicaid fee schedule, then you must write off the difference, even if the commercial insurance states it is patient share. If the charges went to the commercial insurance deductible, then Medicaid MAY pick up part of the deductible, UP to the maximum allowable per the Medicaid fee schedule. I used to run a pediatric practice with 70% Medicaid patients and am very familiar with this.