Bill to medicaid patients - how and when

how and when to Bill medicaid patients

Bill patients only in the following situations:

The recipient's Medicaid eligibility status is pending . If you bill the recipient and they are found eligible for Medicaid with a retroactive date that includes the date of service, you must return the entire amount collected from the recipient and then bill Medicaid. For this reason, it is recommended that you hold claims until after eligibility is determined.

Medicaid does not cover the service and the recipient agrees to pay by completing a written, signed agreement that includes the date, type of service, cost, verification that the provider informed the recipient that Medicaid will not pay for the service, and recipient agreement to accept full responsibility for payment. This
agreement must be specific to each incident or arrangement for which the client accepts financial responsibility.

The TPL payment was made directly to the recipient or his/her parent or guardian. You may not bill for more than the TPL paid for services rendered.

The recipient fails to disclose Medicaid eligibility or TPL information. If a recipient does not disclose Medicaid eligibility or TPL information at the time of service or within Medicaid ’ s stale date period, the recipient assumes full responsibility for payment of services.


you cannot bill the patient for:

For co-payment indicated on a private insurance card

For the difference between the amount billed and the amount paid by Medicaid or a TPL

When Medicaid denies the claim because the provider failed to follow Medicaid policy

Medicaid is the payor of last resort and must be billed after all other payment sources.