Author Topic: Question re: Medicaid as a second insurance  (Read 1327 times)

tdiet0928

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Question re: Medicaid as a second insurance
« on: November 11, 2014, 11:33:34 AM »
I am hoping that someone has the answer to this - my individual provider is credentialled with Medicaid in Pennsylvania and is attached to one of three TINs in our office. Does anyone know if we can bill a COPAY for a client that comes in with a primary insurance. We were told years ago before managed care came in that we could, as long as it was a copay and not a deductible or coinsurance.  I have not been able to find anything in the regulations that states we can't collect the copay, only the ded and/or co-insurance.  The providers are seeing clients under TINs that their MA numbers aren't attached to/credentialled with.  We are seeing more and more clients with primary's come in and then tell us that they have MA secondary. Till we find this out, we are deep into their treatment and have collected alot of money that I think we have to give back. I would love it if someone could point me to the regs giving us a definite answer.

kristin

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Re: Question re: Medicaid as a second insurance
« Reply #1 on: November 11, 2014, 06:33:28 PM »
Well, part of the problem is that the staff isn't getting all the insurance information initially from patients. For patients to suddenly say they have existing Medicaid coverage after several visits have happened needs to be dealt with, immediately. I don't know how you want to handle that, but it needs to be handled. That way, the staff can verify exactly what benefits the patient has with Medicaid before the first visit, and for each subsequent visit, and that determines what can and cannot be collected from the patient.

The TIN/MA number should have no bearing on the situation(so far as I understand), as even providers who are not contracted with Medicaid cannot balance bill QMB's. See this link(relates to Medicare, not commercial primaries, though):

http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/MedicareMedicaidGeneralInformation.html

Then there is this link, specific to PA providers, and it mentions copays:
http://www.cozen.com/admin/files/publications/CT_0812_Rotella.pdf