Medical Billing Forum

Payments => Insurance Payments => Topic started by: ellie on August 11, 2010, 08:51:36 PM

Title: OUT OF STATE MEDICAID
Post by: ellie on August 11, 2010, 08:51:36 PM
Hi everyone,

if a patient had services in one state and is covered thru medicaid secondary in another state, will they pay the bill ?
Title: Re: OUT OF STATE MEDICAID
Post by: Michele on August 12, 2010, 07:29:59 AM
Only if the provider is participating with the Medicaid in the other state.
Title: Re: OUT OF STATE MEDICAID
Post by: ellie on August 18, 2010, 08:41:21 PM
Is the patient responsible for the balance due then if we are not a provider with the other state ?or is it written off ?
Title: Re: OUT OF STATE MEDICAID
Post by: PMRNC on August 19, 2010, 09:34:30 AM
I think it depends. I know that we have had out of state Medicaid and we have to call THEIR state to see if they will approve the out of state. I think you need to call the other state but you also need to participate with Medicaid in your state.
Title: Re: OUT OF STATE MEDICAID
Post by: Pay_My_Claims on August 27, 2010, 07:21:58 PM
yes we had that same situation, and medicaid would not pay, so we were able to bill the patient
Title: Re: OUT OF STATE MEDICAID
Post by: Nadine on December 16, 2010, 08:48:55 AM
I have found that some states provide a pseudo provider number. That is a provider number for that one claim. You could inquire with the out of state medicaid plan....any attempts to collect is worth the effort. nj
Title: Re: OUT OF STATE MEDICAID
Post by: PMRNC on December 16, 2010, 08:53:44 AM
Quote
yes we had that same situation, and medicaid would not pay, so we were able to bill the patient

It really depends, you have to verify with the Medicaid payor, I have billed Medicaid in a few states and there are states that actually will tell you that you cannot bill the patient if you new before hand the provider wasn't participating, if it's an emergency out of state issue, the issuing Medicaid state can offer a prior approval
Title: Re: OUT OF STATE MEDICAID
Post by: Nadine on December 28, 2010, 04:17:18 PM
Try requesting for a pseudo provider number; a one time provider number to bill your claim...nj