Prmiary Medicare Denied Claims will secondary pay?

Claims denied by Medicare are not considered for Medicaid payment through the automated crossover process. Medicaid may consider the claim for “Medicaid only” payment. To determine if the claim may be paid by Medicaid, use the following instructions.

• Complete the claim for “Medicaid only” services, following the claim completion guidelines in the Medicaid Provider Reimbursement Handbook, CMS-1500.
• Attach the EOB from Medicare that reflects the denied service and a note requesting that the claim be considered for Medicaid payment, because Medicare will not cover the service.
• Send all three documents to the area Medicaid office.

If Medicare denied the claim, send the CMS-1500 claim form with the EOMBto the area Medicaid office for consideration. Medicaid will consider payment for “non-covered” services by Medicare for a Medicaid-
covered service. Medicaid will also consider payment if the service exceeds Medicare’s limits, but are within Medicaid’s limits.


Medicare Denial for No Medicare Benefits


If Medicare has denied the claim because the recipient does not have Medicare benefits the provider must:
1. Check if the Medicaid file reflects Medicare coverage for the date of service.
2. Verify that the Medicare claim was filed with the beneficiary Medicare identification number that is on Medicaid’s file.
3. If the recipient’s Medicare number is not correct on Medicaid’s file, contact the Department of Children and Families (DCF) to update the recipient’s Medicare number.
4. Then contact the area Medicaid office for help in filing claims for the recipient.

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