Payments > Insurance Payments

Payment for non par Physician

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Cpatel:
Thanks Michelle,

I billed to MA and will see the output.

Sriram_Sub:
Please share the outcome with us.

Regards
Sriram

Cpatel:
Hello Sriram_Sub

 Medicaid of Maryland advise they will not process the claims because MCO plans manage claims.

Thanks

kristin:
I bill for a specialist provider who sees many MCO plan patients who also have Medicaid(of Pennsylvania) as a secondary. The MCO will pay their part, then the rest is a contractual adjustment, and there is no balance to bill Medicaid at that point. But, for MCO patients he sees where he is not contracted with the MCO/no auth is obtained, they are always self-pay, because Medicaid(at least in Pennsylvania) will not fork over a dime when the MCO denies the claim. That is part of being in an MCO plan...you have to see a provider in that plan, and need an auth, depending.

So for your provider, if he is not in the MCO, he has two choices...1. Don't see the patient, have them see a provider in the MCO 2. Make it a self-pay visit.

Sriram_Sub:
Yes. I agree with Kristin. Medicaid will not pay anything when the HMO has denied the claim as non-par provider.

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