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Texas medicaid claims secondary to other insurance

CPS, C-EMR, PM

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lkeith

(@lkeith)

Posts: 457

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Topic starter

Any Texas Clients.....has anyone run across the issue with Texas Medicaid now requiring a separate code to be billed when the primary carrier has applied a copay to the patient? From an email received from our Provider Rep.

For Medicare copayments you would need to use the codes listed on page 78 of the Claims Filing handbook that I have attached.

CP003 Medicare HMO copayment-professional

CP004 Medicare PPO copayment-professional

For Private insurance copayments you would need to use the codes listed on page 12 of the Third Party Liability handbook that I have attached.

CP001 Private HMO copayment-professional

CP002 Private PPO copayment-professional

Copayments are reimbursed at a maximum of $10 per visit for professional, and up to 4 copayments/day.

For copayments:

Must be filed on a claim separate from services provided. (The only procedure code on the claim should be CP001, CP002, CP003, and CP004. Bill for the services provided as you normally would to the other insurance and follow-up with TMHP for any remaining balance accept copayments.)
Must be received within 95 days of the date of service (date of disposition does not apply to copayments)
Do not list any other insurance other than Medicaid on the claim form.
If filing a Medicare copayment, do not use a MRAN template for the copayment. When filing the claim for the other services provided, do NOT enter the copayment on the MRAN.

This was apparently effective 8/1/17. I have just put in an SR with GE but am wondering if anyone else has maybe come up with a creative way to handle this nonsense!

Linda

Posted : August 30, 2017 4:50 am

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