billing Medicaid

[Anne]

I bill for PT.  We have a new patient - mom of the patient said they had Medicaid primary and when I checked the Medicaid website, that is the only insurance that showed up.  Then the Mom said her daughter has secondary with BCBS.  However, I know BCBS would be the primary if they have that.  Checked benefits with BCBS and found out it's an HMO.  PT provider is not contracted with BCBS, therefore, no benefits will be paid with the primary.  Is it necessary to file first with BCBS, or can I just file with Medicaid, since I know primary will not cover anything and Medicaid doesn't have BCBS info?  Also, will Medicaid pay if reason for primary denial is that provider is not contracted with HMO?   

[Michele]

I'm not sure what state you are in and Medicaid is a state sponsored program, but in NY it is not necessary to bill the primary if the primary is not going to make any payment on the claim since we do not have to attach the primary denial to the claim.

You are correct though, BC would be prime over Medicaid unless the BC HMO is a Medicaid replacement product. 

If they have BC prime and Medicaid 2nd you would just need to file the Medicaid indicating the BC and that there was no payment.  Medicaid should still pay even though provider is not contracted with BC.

Michele

[jns85008]

I'm in Arizona. We still must bill the primary insurance to get the denial and then forward the claim to medicaid as a secondary with the eob to get payment.

[Michele]

Since you have to attach the denial, then you must file with BC first.  I like that we don't have to do that on services that we know will not be covered by the primary.  Saves us time and paperwork.

Michele