How secondary claims are processed by insurance

When the Recipient Has Other Insurance



Introduction 

If the recipient has other insurance coverage, Medicaid payment will be denied
unless the provider indicates receipt of a third party payment or attaches a
denial from the other insurance company or documentation that the other
insurance company will not cover the service.

Note: See Chapter 1 of the Florida Medicaid Provider General Handbook for
information about third party liability (TPL).


Insurance Information on the Remittance Voucher


If the recipient has other insurance, the third party carrier code appears on the
remittance voucher underneath the denied claim.

Note: A list of third party carrier codes and carrier billing information can be
obtained from the Medicaid fiscal agent’s website at
http://floridamedicaid.acs-inc.com or from the fiscal agent’s field representatives.
The field representatives’ phone numbers are listed on the last page of this
chapter.

Note: See Chapter 1 in the Florida Medicaid Provider General Handbook for
information on third party liability.

Record Recipient Insurance Information


The provider should record other insurance coverage information reported on the
remittance voucher in the recipient’s file for future use. Remittance voucher
insurance information is specific to the individual recipient.

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