Medical Billing Forum

General Category => General Questions => Topic started by: angien on November 16, 2011, 11:09:33 AM

Title: NC Medicaid Filing
Post by: angien on November 16, 2011, 11:09:33 AM
Good afternoon,

This is my first post, and I am very happy to have found this forum!

I am having such a difficult time trying to get Medicaid secondary claims paid.  We have a handful that did not crossover automatically from Medicare, and we need to get them paid for our client.  When we try electronically, we receive an error that we need to file via paper, but when we mail in claims, they are denied and we are told to file electronically.  The phone line is no help either.

So my question is, to get a Medicaid secondary claim paid electronically through   what fields need to be completed, and which need to be left blank?  I have a feeling the problem is lying in incorrect keying of primary insurance information (payment, etc), but the MCD reps that I speak to on the phone can't seem to tell me exactly what we're doing wrong.

Thanks in advance for your help!!!!
Title: Re: NC Medicaid Filing
Post by: PMRNC on November 16, 2011, 11:39:32 AM
Not sure how it works there..but I have clients in NY who have nursing home patients with Medicare/Medicaid.. When we encounter one NOT crossing over we usually find out it's NOT been setup by the beneficiary. The cross over link initially has to be made by the patient or family representative if need be.  Once that's done you shouldn't have a problem.
Title: Re: NC Medicaid Filing
Post by: angien on November 16, 2011, 12:48:12 PM
Thank you so much for responding.  We made the link, and it has been smooth sailing since then, but we're having trouble getting past secondary claims paid where Medicare already paid and the crossover to MCD wasn't made.  Like I said, it's just a handful, and since the paperwork was completed, all of our claims have crossed over since then. 

Just not sure how to file the claim for those that didn't crossover to MCD in the beginning when the client was new.  I'm sure it has something to do with populating the wrong fields online but the people on the MCD hotline can't seem to figure out which ones need to be filled in and which ones to leave blank.
Title: Re: NC Medicaid Filing
Post by: angien on November 16, 2011, 01:08:35 PM
Specifically, I have been told to fill in the MCR information in the fields under "CMS-1500 Insurance Detail" as well as "Insured Information" within the CMS 1500 Detail section (where you put in the dates of service, place of service, etc).

Do I need to key the MCR primary info in both places, or is that what is screwing it up?
Title: Re: NC Medicaid Filing
Post by: Michele on November 17, 2011, 06:30:07 PM
I haven't done NC MCaid.  I know sometimes the reps aren't helpful but can they point you to a manual?  Usually they provide you with instructions as to how to use the online system.  I would think it would explain it in there.  We have to do some of our secondaries on the NYS online system and it's terribly complicated.  I can't imagine if we didn't know which fields needed to be completed. 
Title: Re: NC Medicaid Filing
Post by: SLITTLES on November 17, 2011, 06:39:29 PM
Hi, I file NC Medicaid every day.  Are you submitting them through your Clearinghouse or NCECS? 
Title: Re: NC Medicaid Filing
Post by: angien on November 17, 2011, 07:29:19 PM
Michele, Medicaid as secondary does seem terribly complicated, and the manual they pointed me to describes how to complete the form with Medicaid as primary but not as secondary. 

Slittles, I am filing through NCECS.  Thanks in advance for any advice!