The rules may change when they are the secondary payer not the primary payer. I would bill them using the 59400 with the EOB from the primary and wait to see if they deny it. These are tricky situations to figure out. Is there anything in the billing instructions from Texas Medicaid on how to bill when they are secondary? Sometimes they already have addressed this situation. The other thing that comes into play here is, if the primary has already allowed as much, or more than, what Medicaid would have as primary, then you have to write off the difference anyway. That is what happens in Washington State with a lot of the Medicaid secondary claims.
Originally Posted by k_isabel04
"Texas Medicaid Provider Billing Manual...
Medicaid-eligible clients may not be held responsible for billed charges that are in excess of the TPR(Third Party Resources)
payment for services covered by Texas Medicaid. If the TPR(Third Party Resources) pays less than the Medicaid-allowable
amount for covered services, the provider should submit a claim to TMHP (Texas Medicaid Health Program) for any additional allowable
Last edited by ajs; 11-08-2011 at 04:35 PM.
Reason: additional info
Arlene J. Smith, CPC, CEMC, COBGC
AAPC Tacoma WA Chapter
Past-President 2013 and 2011
Member Relations 2008
AAPC NAB 2007-2009