Billing medicaid when patient has private

[ZakMeister]

So a patient has medicaid (kid) but he is also on his mom’s cigna plan. I don’t know why the medicaid didn’t pick up on this and rejected a claim saying to bill the primary.


Today I processed a claim for humalog thru cigna and the copay was ridiculous (+$500 most likely deductible). Patient returned a call saying to bill thru her son’s medicaid and that her employer is switching their plan. Would it be ethically appropriate to bill the medicaid when there is a primary available? I did bill the medicaid and it was a 0 copay

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[Flagrant222]

So a patient has medicaid (kid) but he is also on his mom’s cigna plan. I don’t know why the medicaid didn’t pick up on this and rejected a claim saying to bill the primary.


Today I processed a claim for humalog thru cigna and the copay was ridiculous (+$500 most likely deductible). Patient returned a call saying to bill thru her son’s medicaid and that her employer is switching their plan. Would it be ethically appropriate to bill the medicaid when there is a primary available? I did bill the medicaid and it was a 0 copay

C...

 

[zelman]

You need to split bill it. Medicaid has to be updated on the patient's primary insurance info. If you bill them primary, you're just raising your own taxes.

 

[steveysmith54]

I believe you're suppose to do a COB/split bill. Bill the copay thru medicaid.

 

[ranger99rx]

Bill Cigna first them Medicaid as secondary, that way patient will meet deductible with primary insurance eventually and you are safe for auditing purpose.

 

[BidingMyTime]

In IL, legally the private ins must be billed first, you can then bill the co-pay (or entire amount if not covered by the private ins) to Medicaid.