Saturday, September 17, 2011

Denial - Recipient Has Other Insurance - what we need to do

When the Recipient Has Other Insurance

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 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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