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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