MEDICAID

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Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources. Medicaid offers benefits that Medicare doesn’t normally cover. People with Medicaid usually don’t pay anything for covered medical expenses but may owe a small co-payment for some items or services.

Medi-Cal It is California’s Medicaid health care program. This program pays for different medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes.

Medicare is a federal health insurance for people 65 years or older, and people under 65 with certain disabilities or conditions.

STRAIGHT MEDICAID / MEDICARE vs MANAGED MEDICAID / MEDICARE

MEDICAID WRITEOFFS

If the patient receives a billing statement because their STRAIGHT MEDICAID insurance did not cover the test. In that case, they should not be held responsible for payment if their MEDICAID insurance did not cover it.

In this case, if the patient receives a bill for the test that MEDICAID insurance did not cover, you must submit a  Supervisor Escalation on Syncro CRM to have the patient’s balance removed.

Place a hold on the statement by selecting Statement Cycle = HOLD, and the required release type is NCS.

Once the Syncro CRM escalation has been sent it will take 5-7 business days to have the patient’s balance written off.

If Straight Medicaid denied a claim due to Timely Filing, the balance will be written off after you send a Supervisor Escalation through SyncroCRM (Ensure the patient had Medicaid coverage at the DOS)

If the patient is receiving bills after processing a Medicaid insurance update and the TAT is already exceeded, please check the statement generation date to verify if it was generated before the process was completed, send a Supervisor Escalation through SyncroCRM, so your CSS can submit a Medicaid Eligibility Review.

MEDICAID FAQS
  • How can we identify if the patient has Straight Medicaid or Managed Medicaid? Straight Medicaid will have a state with it for payor ID & they do not leave any patient responsibility. Example:  Medicaid of New York, Georgia Medicaid, etc. Managed Medicaid will show insurance name + Medicaid
  • If Straight Medicaid did not cover the service because testing occurred before the insurance’s effective date. Is the patient responsible for that invoice? Yes, if the patient didn’t have any insurance on the date of service the patient is responsible for the invoice amount.
  • If Straight Medicaid denied a claim due to Timely Filing, should the balance be written off? ANY insurance that denies for timely filing is to be written off
  • What would be the procedure if a patient who has Managed Medicaid receives an invoice for a remaining deductible? It’s not often to see a deductible but a copay; if that happens, offer the patient compassionate care; if they qualify for Medicaid, they may also qualify for our compassionate care.
  • If the patient has primary insurance who left any deductible or coinsurance, does Straight Medicaid take the remaining if the patient has it as secondary? Medicaid will most likely NOT pay as the primary paid more than they would so the balance will be written off to a zero balance and the patient gets no statement from Natera
  • Does Medi-Cal work as Straight Medicaid and Managed Medicaid? If so, Medi-Cal patients will also have a co-insurance with Managed Medi-Cal? Medi-Cal is considered Straight Medicaid and should have no balance

 

Last update by: Claudia F (August 12, 2024)

 

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