Medical Billing Forum

Billing => Billing => Topic started by: ABABiller on September 21, 2017, 10:29:07 AM

Title: Medicaid Secondary
Post by: ABABiller on September 21, 2017, 10:29:07 AM
Hello all,

We are an ABA company and each insurance company has different codes for services. I have this case where United is primary and Medicaid is secondary. As I mention the codes that we are contracted to bill for services with each insurance do not match.

So my question is: Before submitting claim to Medicaid, do i need to change the billing codes to match our contract? Or since Medicaid is secondary will they cover regardless of the codes since primary already reimbursed? Also do i need to request authorization thru Medicaid as well?

I tried contacting Medicaid for answers but they just gave me the run around.

Thank you for all your help!!!  ;)
Title: Re: Medicaid Secondary
Post by: Michele on September 21, 2017, 12:53:10 PM
You would need to change the code when billing Medicaid to one of the codes per your contract.  (The code must match the service obviously.  Just wanted to make sure I mentioned that you should never change a code strictly to get something paid, but we have seen situations where one code is used with one insurance carrier and a different code is used with another for the exact same service.)

You should contact Medicaid.  Most secondaries do not require auth when they are secondary and the primary is paying.  However, you should find out for sure.  If it is a service that Medicaid usually requires auth for then you may have to obtain auth.
Title: Re: Medicaid Secondary
Post by: PMRNC on September 21, 2017, 01:32:51 PM
I have run across situations where in NY Medicaid will want us to change codes, however once I contact them, advise them the primary paid according to proper CPT guidelines, this usually prompts them to reconsider the claim. They should NOT be asking for you to change codes for purpose of secondary billing.

Title: Re: Medicaid Secondary
Post by: Michele on September 22, 2017, 07:28:37 AM
We've experienced the opposite.  We were told by NY Medicaid that they cannot process the claim with a code that is not in their system and since it is a covered service, we need to change the code to the code that they require.