Question
QUESTION: Hello Good day,
I am working in Healthcare domain. We are having some kind of problem while billing claims to secondary Medicaid of Texas. I explained scenario below...
Patient XXXX has Medicare HMO and Medicaid [TX] secondary. We are receiving payment from MCR HMO without any issue. But when we bill secondary Medicaid with HMO EOB, claims are getting denied as "Member has Medicare advantage plan". When we called to Medicaid, they are suggesting to bill the claim with Medicare EOB. Please advice, How to handle this issue. Because, If we bill Medicare, they will deny the claim as ?covered by another payer"... How to fix this problem...
Thanks
Jack
ANSWER: Just as Medicaid said, you need to bill Medicaid after Medicare HMO paid and send a copy of the EOB showing the payment details.
Good luck
---------- FOLLOW-UP ----------
QUESTION: Thanks for your prompt response.. But In my question , I mentioned as " Medicaid Need Medicare EOB". They are not requesting MCR HMO EOB.. awaiting for your response...
Thanks
Jack
Answer
Medicare HMO is still a Medicare product. Regardless of who the primary insurance is (Medicare, Medicare HMO, Commercial Insurance, employer provided insurance, etc...) Medicaid will always need the EOB, how else can they determine, how much has been paid (if any) and make a determination of what they will pay?
Good luck
