"splitting" claim

lfinns

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Can you "split" a claim and bill to 2 different payers what it theirs? We are billing Medicaid and Access -KP. Access KP will only pay a particular number of codes (2000 of which 20 apply to us) and Medicaid pays the other codes. Currently we bill everything to Medicaid, they pay the codes they are responsible for and then we bill KP for the codes they will pay. We would like to divide the claim and bill each payer just what they will pay for simplicity, speed and time efficiency. Can we do this kind of split billing? Is this information in writing somewhere?
 

Pam Brooks

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You must bill the primary payer first, and then balance bill the secondary payer. Your payer contracts will have outlined this for you.
 

mcpalmeter

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"splitting claim"

Can you "split" a claim and bill to 2 different payers what it theirs? We are billing Medicaid and Access -KP. Access KP will only pay a particular number of codes (2000 of which 20 apply to us) and Medicaid pays the other codes. Currently we bill everything to Medicaid, they pay the codes they are responsible for and then we bill KP for the codes they will pay. We would like to divide the claim and bill each payer just what they will pay for simplicity, speed and time efficiency. Can we do this kind of split billing? Is this information in writing somewhere?

Is this for Colorado Medicaid?

Access-KP is not a secondary payer. They are an ACO for Medicaid.

I found a fact sheet on the Access KP website. Looks like you would bill 2 separate claims - one to Access-KP for one of the 2000 codes they are financially responsible for and all other codes would be billed through the usual state Medicaid intermediary.

Here is the link:

https://static1.squarespace.com/sta...474250348507/Access-KP-Program-Fact-Sheet.pdf
 

lfinns

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Yes its for Colorado Medicaid. I have that fact sheet as well and was trying to decide how to interpret it. I was thinking that they meant 2 separate claims, but was wanting to be sure before we billed it that way.

Thanks for your help:)
 
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