In the state of Pennsylvania you can have a private individual or group plan of insurance in addition to Medicaid. Most of this provider's patients are children and have special needs and medicaid pays for these evals for determining wrap around and TSS services. What I need to know is if anyone is familiar with PA regs and know if there is anything I am missing in regards to Medicaid being the payor of last resort. If they have a private/group plan in addition to Medicaid does the private ins have to be billed first or is there an exclusion to this that I may not know about.
it may vary as far as the criteria is concerned about obtaining medicaid, but what is across the board is that if you have medicaid from any state, it is always billed last. Medicaid will never be the primary payor to any insurance.