Wiki Reporting to Medicaid

[nancydavenport]

When a patient has a commerical insurance as primary and a medicaid as secondary, are we supposed to send zero balance claims to the secondary? For example if a well visit is paid in full by the primary with vaccines, do I still need to send it to Tenncare for reporting purposes. If so, how do you do that to avoid an overpayment?

 

[suki_26]

I can't speak for Tenn. but I can for NY... if they are not going to pay it, we don't send it. ANY OTHER insurance yes we do to get the EOB and show proof but as for EMEDNY ( NY Medicaid ) it is such a hassle to even bill them and then the EOBS that come back are horrible to read. In NY the only thing they pay is deductible and just a couple vaccines. They wont cover coinsurance and if the claim isn't perfect they wont even cover the deductible assuming it was sent in within 90 days from original date of service. Here in NY you Can Not balance bill a Medicaid Patient so for the amount of work needed to process the claim that isn't going to be paid... in our opinion, its not worth it. ( we are PCPs) depending on your specialty they may pay differently.

 

[rthomas@impcna.com]

In Mississippi if the claim was for wellness visit or vaccines and the primary pays 100% we still have to send to Medicaid/Managed Care Plan because they track the compliance of their patients. One of our Medicaid plans pays patients so having their wellness exams done. We have had the carrier contact us and tell us that we have to bill them even if the primary pays 100%