Medicaid claims
that are secondary to insurance or
Medicare coverage, including Medicare HMOs, may be
billed electronically either through electronic vendors or through Molina’s web
portal. Contact the EDI Help Desk for access to submitting claims on the
web portal.
Medicare Primary Claims
Many Medicare primary claims crossover to Medicaid automatically from the
Medicare Part A and Part B carriers through the Coordination of Benefits
Agreement (COBA), but some do not. Claims that do not crossover, and
therefore must be billed separately by providers include:
*** Outpatient claims from Part A Medicare carriers (such as NGS)
*** Long Term Care (LTC) claims from Part A Medicare carriers
*** Anesthesia claims from Part B Medicare carriers (on crossover, these are
rejected because
claims are billed in “minutes” not “units”)
*** Claims processed by Medicare HMOs.
All of these types of claims may be billed electronically to Medicaid.
Medicare paid amounts, deductible amounts, and coinsurance amounts are
required for Medicare approved services and Medicare Action Codes are required
for services denied by Medicare. This information is re-quired at the
claim line level for professional services billed on the 837P format and at the
head-er level for institutional services billed on the 837I format.
*** Allowed amount, paid amount, deductible, and co-insurance information
must be billed in the Medicare segments, not the TPL segments, or the claim
will not process correctly.
