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CAN WE BILL MEDICAID WHEN IS IS SECONDARY

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swamy:
We Have primary as Medicare and secondary ins as Medicaid, Medicare paid and secondary open amount is Less then 20% of Medicare allowed amount, do we get payment from Medicaid or do we have to write off the balance?

Michele:
Medicaid should make payment.  Any balance after Medicaid makes payment would be written off.

Michele

swamy:
Thank you very much !!!

I have one more question about ERA remits, In ERA remit file, if we are not receiving SVC segment, how we will be handling in software and where we can get the DOS for that payment.

once again thank you for your reply, and please suggest me if i am posting the query in the wrong section.

Michele:
I'm not sure if I understand what you are saying.  The ERA should have all the same info as a paper remit.

Michele

PMBS:
To my understanding Medicaid is a payor of last resort so if Medicare as primary paid more than what Medicaid would pay they do not pay anything.  I am Florida so I don't know it works different if you are in a different state.  We usually write of the balance if a patient has Medicaid.  The only thing Medicaid pays for is the deductible.  I called Medicaid on this many times and was told that because of the balance budget act we can not bill the patient.

However, there are some Medicaid plans that only pay for the patient's Medicare Premium and in that case we can bill the patient.

I hope this helps.

MR

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