Sunday, April 3, 2011

Not covered by Medicare, can we submit to secondary insurance?


Not all services covered under the Medicaid Program are covered by Medicare. (Examples are: prescription drugs, eyeglasses, most dental services, hearing aids, adult day health care, personal care or most eye exams performed by an optometrist.) In addition, some benefits that are provided under Medicare coverage may be subject to certain limitations. The provider will receive a Medicare Remittance Advice that indicates if a service has been denied by Medicare. The provider may submit a claim to Medicaid, using the proper claim form for consideration of reimbursement.

To bill Medicaid for a service that has been denied by Medicare, the provider may file a paper claim and attach a copy of the Medicare Remittance Advice that indicates the Medicare denial for the service billed to Medicaid. Highlight the Medicare denial of the service on the Medicare Remittance Advice by circling or using an asterisk.

File the paper claim using the instructions found in Section 15. If Medicare denies any service on the claim, the denied services only should be listed on the Medicaid claim.

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