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Medicaid enrollment issue


Not sure if I picked the correct forum for my question, but this involves a new phase of my billing business.  Two PT's who treat pediatric patients under the age of 18 formed a group - they have their new group tax ID's, group NPI #'s,etc.   Most of the patients have Medicaid as secondary ins.   However, they recently applied for a  TX Medicaid group ID (with the idea of hiring other PT's and PT assist. to treat some of their patients) and were turned down, with Medicaid saying they cannot do that.  Medicaid rep. says that they can only file using their indiv. provider ID. They have spoken w/ several people at Medicaid and get conflicting answers, or someone will call back and hasn't yet called back.  My question is - IF it's true that they can only file for the secondary using indiv. ID's (which doesn't make sense to us, since other ins. carriers seem to be ok with it) - how do I file the Medicaid secondary, if primary ins. was billed using the group #'s?  I now have several EOB's from primary with the new "group" name and group #'s.  My providers haven't even applied for the TX Medicaid individual ID yet, and there's a 90 day time frame with which to file the secondary.  Should I resubmit to the primary explaining that we need a new EOB with their individual tax ID's??  This is very confusing - so if you need me to clarify my question, please ask - I'll try to do that.   thank you, Ryanne

Alice Scott:
   We actually have run into similar situations here in NY.  If you file your Medicaid 2ndaries on preprinted Medicaid forms it doesn't matter what tax ID or NPI number the primary insurance paid under.  That is how we file them here and you just need to fill out the Medicaid form with the correct info for Medicaid, not what the primary has.  If you submit them electronically (2ndaries) then you just need to set up your  electronics for Medicaid with the individual info.  As for the 90 day rule, it will depend on when they make the provider numbers effective.  Then you would just submit with a 90 day letter stating "administrative delay"

Good Luck!

thank you - very helpful


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