Medicaid insurance is a program of the government to help low-income individuals and families to cope with the costs of healthcare. It is one of the most popular insurance in the US which covers a majority of the population. Pregnant women, people with disabilities, children, and the elderly are among those that are given health coverage under the program.
Types of Medicaid Coverage Offered
Eligibility for Medicaid batch claims processing varies from state to state. However, each state must follow certain guidelines imposed by the government. As per the government, Medicaid claims must follow specific medical coding processes to bill for procedures.
Medicaid falls into major two general types:
• Community Medicaid
It assists eligible beneficiaries who have no or very little medical coverage.
• Medicaid Nursing Home Coverage
It pays for nursing home costs for recipients. These beneficiaries pay most of their income toward nursing home costs.
Know the Prerequisites Before Applying
Before billing for a Medicaid patient, you need to research the state’s Medicaid billing requirements. Verifying a patient’s eligibility status with Medicaid is usually difficult. You can verify whether the patient has it and whether a referral is needed. If there is one, it can’t be determined until after the claim has been submitted for consideration. If the patient has kept Medicare advised, the claim usually crosses directly. It has been found that Medicaid usually pays in accordance with its fee schedule.
Program eligibility is determined by income and access to financial resources. In addition to demonstrating poverty, though, eligible recipients fall into another eligibility category as defined by CMS. The categories include age, pregnancy, disability, blindness, etc. Special exceptions are made for people in nursing homes and disabled children at home. A child, for example, might be eligible, regardless of the eligibility of the parents or the guardians.
The Process of Acceptance
Medicaid batch claims processing must be received within 365 days of the first date of service. It needs to be accepted for processing and payment. The claim and supporting documentation to prove timely filing must be submitted on the appropriate paper claim form to your Provider Representative.
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