Medical Billing Forum
Billing => Billing => : jc071172 June 15, 2012, 11:54:18 AM
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Can anyone think of or know of any frequent scenarios where Medicaid is Secondary to the Primary claim, other then if the patient has Medicare? I only know of this one scenario, that if the patient has Medicare and a Medicaid plan, then Medicare is Primary and Medicaid is secondary. All other Medicaid cases that I have seen frequently is the Patient having only one plan and one plan only, Medicaid. Thanks.
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I have ONLY run into Medicare/Medicaid or Medicaid ONLY.
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Thanks DMK......that's all I had seen also.
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I have seen both cases. It really depends on state guidelines and the person's income level. I have billed for medicaid as secondary with medicare as primary, with BCBS as primary, and with Aetna as primary and Medicaid pays as the secondary for all of them.
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To be frank and honest.. only time I have seen it is in cases of fraud. I normally will verify with Medicaid if there is a primary to Medicaid. 99.9% of the time I was right to verify it.
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I have seen it a couple of times. If it is a child and the child has a disability they may automatically qualify for Medicaid (not by income), but either one or both parents work and have insurance. The parents insurance is prime and Medicaid is secondary.
Actually my nephew has this scenario. He has a disability and both parents work. Him mother has insurance thru the state (state employee) and her insurance is (actually was since he's now older) prime, and Medicaid paid the copays.
I've seen it with other disabled children too.
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I bill for a pediatric OT - many of her clients have medicaid as secondary, primarily disability related, with various commercial insurances as primary.
Adrienne
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We see Blue Cross/ Medicaid or Century/ Medicaid here our facility. We see a few children with Medicare/Medicaid.