bethb
Guru
Good afternoon!
Anyone out there from the state of North Carolina? I am having trouble finding clear answers regarding primary insurance and secondary Medicaid billing. I also work on billing for Pennsylvania providers and have a firm grip on Pennsylvania's rules with regard to Medicaid secondary claims. Having trouble with NC, though.
Anways, if a patient has a Blue Cross/Blue Shield primary insurance (or any non-Medicare plan-i.e. commerical-Cigna) with a $35.00 co-pay (patient does not pay co-pay at time of service) and BCBS pays at their allowable amounts (provider is in-network with BCBS and Medicaid) and the balance left is the co-pay, does Medicaid have any responsibility to pay the co-pay amount? I've talked to several representatives at Medicaid in NC and have been told that Medicaid (in NC) will consider deductible / co-insurance balances after a primary insurance pays but has no responsibility to pay co-pay balances.
If Medicaid has no responsibility to primary insurance co-pay balances, then is the patient liable for the co-pay amount or is it an adjustment?
Co-pays are in the member's contract but what happens if the member has Medicaid as their secondary?
Anyone have any insight?
Thank you in advance for your time!
Beth
Anyone out there from the state of North Carolina? I am having trouble finding clear answers regarding primary insurance and secondary Medicaid billing. I also work on billing for Pennsylvania providers and have a firm grip on Pennsylvania's rules with regard to Medicaid secondary claims. Having trouble with NC, though.
Anways, if a patient has a Blue Cross/Blue Shield primary insurance (or any non-Medicare plan-i.e. commerical-Cigna) with a $35.00 co-pay (patient does not pay co-pay at time of service) and BCBS pays at their allowable amounts (provider is in-network with BCBS and Medicaid) and the balance left is the co-pay, does Medicaid have any responsibility to pay the co-pay amount? I've talked to several representatives at Medicaid in NC and have been told that Medicaid (in NC) will consider deductible / co-insurance balances after a primary insurance pays but has no responsibility to pay co-pay balances.
If Medicaid has no responsibility to primary insurance co-pay balances, then is the patient liable for the co-pay amount or is it an adjustment?
Co-pays are in the member's contract but what happens if the member has Medicaid as their secondary?
Anyone have any insight?
Thank you in advance for your time!
Beth