SECONDARY MEDICAID CLAIMS DENIED AS “MEDICARE COVERAGE IS PRESENT”

DESCRIPTION OF THE ISSUE
Secondary Medicaid denied claims as Medicare coverage is present/ Crossover data missing at detail level. As per our conversation with Medicaid they do not cover the balance left from Primary Medicare HMOs.

CONCEPT
If patient have Medicare HMO as primary Insurance and Medicaid as secondary, such scenario claims have been denied like this.

SOLUTION
Before we bill claims to Secondary Medicaid we need to check the paid amount of the primary carrier with Medicaid fee schedule and if the amount greater than the Medicaid allowable we could waive the balance off

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