I have been struggling to bill medicaid secondary due to it’s timely filing.
I have no trouble billing medicaid secondary when Medicare is primary because for some reasons they only recognize adjustment codes from Medicare ERA’s when done through our EMR, so all I have to do is click submit. This DOES NOT work when its from a Medicare DUAL ADVANTAGE PLAN. I’d get the "patient has other coverage denial" not recognizing that those adjustment codes are from that "other coverage." I’m forced to tediously enter the adjustment codes for each and every claim and all the demographic and primary insurance information on emedny epaces. It takes me about 5 minutes to do each claim, some times more because this method is so error prone. Although the medicaid manual requires you to bill them as secondary within 30 days of your control from the date of the primary E.O.B. they used to pay the claim if it’s done within 120 days so as long as you use "7" (delay due to primary) as your delay reason. Then without warning they changed it to 90, which caused me to scrap a whole month of claims. Just today without warning their system dropped it to 60 days so I had to scrap another 30 days worth of claims which is still 1000’s worth of claims. This is extremely unfair especially both times with no warning. We get like over 200 medicaid secondary claims a month. It’s impossible for a single biller to handle all this data entry per a medicaid claim. It’s just way too time consuming for the poor amount that they pay when I have to prioritize higher paying claims. But in large numbers it is a lot.
I have no trouble billing medicaid secondary when Medicare is primary because for some reasons they only recognize adjustment codes from Medicare ERA’s when done through our EMR, so all I have to do is click submit. This DOES NOT work when its from a Medicare DUAL ADVANTAGE PLAN. I’d get the "patient has other coverage denial" not recognizing that those adjustment codes are from that "other coverage." I’m forced to tediously enter the adjustment codes for each and every claim and all the demographic and primary insurance information on emedny epaces. It takes me about 5 minutes to do each claim, some times more because this method is so error prone. Although the medicaid manual requires you to bill them as secondary within 30 days of your control from the date of the primary E.O.B. they used to pay the claim if it’s done within 120 days so as long as you use "7" (delay due to primary) as your delay reason. Then without warning they changed it to 90, which caused me to scrap a whole month of claims. Just today without warning their system dropped it to 60 days so I had to scrap another 30 days worth of claims which is still 1000’s worth of claims. This is extremely unfair especially both times with no warning. We get like over 200 medicaid secondary claims a month. It’s impossible for a single biller to handle all this data entry per a medicaid claim. It’s just way too time consuming for the poor amount that they pay when I have to prioritize higher paying claims. But in large numbers it is a lot.
I wonder if I’m the only one struggling with this.
If there’s a better way, please let me know.