Billing > Billing

medicaide as secondary for OB

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Trisha Reyes:
Hi Michele,

I am in TX, a provider bills a com. ins. for delivery (which is pd. as global) using 59140, medicaide is the secondary ins. but does not use the global CPT code, it has to be submitted using 59400 and they are not paying, saying the amount pd. by the primay ins. exceeds their allowable. How do I get this pd. when there is still a 600.00 balance?

Thanks for the help,
Trisha

Michele:
Trisha,
   I would call Medicaid and ask if you are doing something incorrect.  Medicaid is state sponsored so it varies from state to state.  In NY, they go by what Medicare allows when they are secondary, not what they allow, as long as the code being billed is a payable medicaid code.  You should call Medicaid and ask how they process Medicare prime claims, and see if there is a problem with the way you are submitting the charge.

Good luck
Michele

marypete:
I have noticed that since Medicaid is considered the payer of last resort, that if the commercial insurance pays more than Medicaid would have allowed for a service as primary, that they will not pay any additional money.  I would call my representative, and ask them if this is the case for this code, or if you need to bill it in some other way.

Bev:
  I would like to add:  In the case of a copay (for a regular visit, not necessarily for OB or OB delivery), and Medicaid is secondary, can we collect the copay?  Or do we bill Medicaid as secondary and ignore the copay (I am being told that in Pennsylvania that I cannot collect the copay because I am par with PA MA and the amount paid by the primary exceeds PA MA's allowable, therefore, the copay would not be paid and should not be collected.  How does this sound to you? Correct or incorrect?

Also, do we have to bill Medicaid when we know they're not going to pay additionally as the primary amt paid is greater than the Medicaid allowable?   :P

Michele:
If they patient has Medicaid, you can't collect the copay.  But I would still bill it out to Medicaid.  In NY, Medicaid pays the copays even if the allowed amount is over the Medicaid allowed amount.  I'm not sure in Pennsylvania.


Michele

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