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Payment for non par Physician

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I need advise on this please: If Physician is non par with MCO plan then can we bill to Medicaid after MCO plan denies the claim for auth/non par provider? If not then how the Physician can get paid if patient is seen?

Which State's Medicaid? Because it may vary based on the State.


It is state of Maryland.

Your best option is to contact Your state Medicaid, but basically if you saw the patient and knew they had Medicaid (primary or secondary it doesn't matter) you are most likely out of luck with this if your provider is not a Medicaid provider.


The physician is non par with the MCO but par with Medicaid correct?  So the MCO is not paying and you want to bill it to Medicaid.  Sriram_sub is correct that you need to check with Maryland but I believe you can bill it to them as long as you indicate why the primary (MCO) didn't pay.  If you submit on paper, then include the EOB.  If you submit electronically, indicate the appropriate reason for non payment (provider not par).  Then they will decide whether or not they will cover the services. 


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