When we can billing Medicaid patients?

We cant send the statement to Medicaid patient unless untill there are some valid reason behind it.
Other than copayments and coinsurance, the provider cannot seek payment from a recipient for a compensable service for which a claim has been submitted, regardless of whether the claim has been approved, partially approved or denied except under the following circumstances:

• The recipient is not eligible to receive Medicaid services on the date of service.

• The service the recipient receives is not covered by Medicaid.

• The provider has verified that the recipient has exceeded the Medicaid coverage limitations or frequency cap. The provider must inform the recipient that he or she has exceeded the frequency cap for the specific

service to be rendered.
• The recipient is enrolled in an HMO, PSN or in MediPass and has been informed that the particular service has not been authorized by the HMO, PSN or MediPass primary care provider.

• The recipient is enrolled in an HMO or PSN and has been informed that the treating provider is not a member of the recipient’s HMO or PSN network.

• The provider has informed the recipient in advance that he or she does not accept Medicaid payment for the specific service to be rendered. The provider must document in the recipient’s medical record that the recipient was informed and agrees to the service.

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