In the United States, Medicaid is a health insurance program that covers low-income individuals and families. For those who have Medicaid as a secondary insurance, it’s important to understand how to bill it correctly to maximize reimbursement potential. In this article, we’ll explore the steps to take when billing Medicaid as secondary insurance.
Step 1: Understand Medicaid’s Role as Secondary Insurance
Medicaid is considered secondary insurance when an individual is enrolled in another health insurance program, such as Medicare or a private health insurance plan. When Medicaid is secondary, it will only pay for services that the primary insurance does not cover.
Example:
If an individual with Medicaid as secondary insurance receives a medical service that costs $500, and their primary insurance covers $400 of the cost, Medicaid will only cover the remaining $100.
It’s important to note that Medicaid will only act as secondary insurance if the individual has informed the provider of their status. This can be done by giving the provider both insurance cards at the time of service.
Step 2: Verify Coverage and Benefits
Before providing any medical services, it’s important to verify that Medicaid will cover the service as secondary insurance. You can do this by calling the Medicaid provider services number or checking online.
It’s also important to understand the benefits and limitations of Medicaid as secondary insurance. The benefits can vary depending on the individual’s primary insurance plan.
Example:
Medicaid may only cover services that are medically necessary and not covered by the primary insurance. Medicaid may also have a limit on the number of visits or procedures that it will cover.
Step 3: Bill Medicaid as Secondary Insurance
When submitting a claim to Medicaid as secondary insurance, it’s important to follow specific steps to maximize reimbursement potential. These steps include:
- Submit the claim to the primary insurance first.
- Include the Explanation of Benefits (EOB) from the primary insurance.
- Include the Medicaid Explanation of Benefits.
- Submit the claim within a specific timeframe (varies by state).
Example:
If an individual receives a medical service that costs $500 and their primary insurance covers $400 and Medicaid covers the remaining $100, the provider will bill the claim through the primary insurance first. Once the EOB is received, the provider will submit the claim to Medicaid with both the EOB and the Medicaid Explanation of Benefits. Medicaid will then reimburse the provider for the remaining balance.
Step 4: Review Remittance Advice
After submitting a claim to Medicaid as secondary insurance, it’s important to review the remittance advice received from Medicaid. This will provide details on how much Medicaid reimbursed and any denials or adjustments made.
Providers should review the remittance advice to ensure that Medicaid reimbursed the correct amount and to identify any issues that may need to be addressed in future claims.
Step 5: Follow up on Denials or Adjustments
If Medicaid denies or adjusts a claim, it’s important to follow up to determine the reason for the denial or adjustment. This can be done by calling the Medicaid provider services number or checking online.
Once the reason for the denial or adjustment is determined, providers can take steps to address the issue and resubmit the claim if necessary.
Conclusion
Billing Medicaid as secondary insurance can be a complex process, but understanding the steps involved can help providers maximize reimbursement potential. By following these steps, providers can ensure that they are billing Medicaid correctly and receiving the appropriate reimbursement.
FAQs
- What is Medicaid?
- What does it mean when Medicaid is secondary insurance?
- How do I inform my provider that I have Medicaid as secondary insurance?
- How do I verify that Medicaid will cover a service as secondary insurance?
- What should I do if Medicaid denies or adjusts a claim?
Medicaid is a health insurance program that covers low-income individuals and families in the United States.
When an individual has Medicaid as secondary insurance, it means that Medicaid will only pay for services that the primary insurance does not cover.
You can inform your provider of your Medicaid status by giving them both insurance cards at the time of service.
You can verify coverage by calling the Medicaid provider services number or checking online.
If Medicaid denies or adjusts a claim, you should follow up to determine the reason for the denial or adjustment and take steps to address the issue and resubmit the claim if necessary.
References
Centers for Medicare & Medicaid Services. (n.d.). About Medicaid. Retrieved from https://www.medicaid.gov/about-us/index.html
Medicaid.gov. (n.d.). Medicaid as a Secondary Payer. Retrieved from https://www.medicaid.gov/medicaid/eligibility/medicaid-as-a-secondary-payer/index.html