Author Topic: Out of state Medicaid policy ...  (Read 1043 times)

jdorn

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Out of state Medicaid policy ...
« on: February 03, 2014, 03:03:50 PM »
We have several urgent care centers and a growing issue is patients presenting out of state medicaid cards  - Here's the problem:

You have no clue they are out of state medicaid until you call and verify or until you receive a letter of denial back.
Since we are an urgent care we do not call and verify benefits prior to being seen.
We are also a non profit organization so for out of network insurance's we only require a small amount down to be seen so after the denial we never receive any futher payment from these patients.

We have listed on the patient documentation form that only NC Medicaid will be filed, no others will be billed - however they sign it and still give us the Medicaid card which they know is Medicaid even though we do not.  We still will bill the patient since this was something they were made aware of ahead of time.

I would just really like to know how this is handled in other offices.. 

Should we look into a new policy? List this information somewhere open to the public?  We are also considering hiring someone to call and verify benefits prior to being seen but this has to be looked at budget wise. 

Merry

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Re: Out of state Medicaid policy ...
« Reply #1 on: February 03, 2014, 05:19:17 PM »
 Can you check benefits online with your Medicaid carrier? Since you are familiar with what the ID looks like for your state, you can deny the others  care unless it is a true emergency and then I assume that you would send them to the ER anyway.

I think training your office staff that you have would be my first choice since you are non profit. I am sure that people know that you will see them even if they have Medicaid from another state. Word does get around.

Sounds like you should tighten up your office policies about seeing people who are out of state Medicaid or for that matter any other insurance that you are not familiar with. Even an out of state HMO will not be paid unless a true emergency (unless that plan is also licensed in your state)

I guess my confusion is:..do NC Medicaid recipients have a unique ID card that you can identify at a glance?

Another suggestion is to hire one person for all of your facilities and scan and fax the cards for them to verify before the patient is seen. A lot of work for one person.

I am sure that you will get other ideas here.

Merry

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Re: Out of state Medicaid policy ...
« Reply #2 on: February 03, 2014, 10:45:15 PM »
Quote
You have no clue they are out of state medicaid until you call and verify or until you receive a letter of denial back.

Hmm.. not sure about that.. if you are given the face sheet.. you can and should be verifying your own benefits. Out of state Medicaid should make no difference, you need to make sure your face sheets contain the info YOUR practice needs and if they don't .. yell about it.. you need to have accurate face sheets!
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Michele

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Re: Out of state Medicaid policy ...
« Reply #3 on: February 04, 2014, 09:47:27 AM »

I guess my confusion is:..do NC Medicaid recipients have a unique ID card that you can identify at a glance?


Merry


I'm thinking the same thing.  Can't the desk person tell by looking at the card that it's an out of state Medicaid?  I'm wondering if the front desk person can't just be a little more diligent about catching these before they are seen.  Also, since it seems to be a problem I would post a note very visible to the check in area as well.
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shanbull

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Re: Out of state Medicaid policy ...
« Reply #4 on: February 04, 2014, 10:39:26 AM »
Our state has a verification website for our Medicaid program, eligibility and benefits verification takes about 20 seconds. I'm not sure how common this is in other states, but maybe look into it? It's much faster than calling for the information.