eClaims - Medicaid Billing

Medicaid is administered by the individual state. The requirements of the Medicaid of one state may differ vastly from the requirements of the Medicaid of another state entirely.

Some Medicaid requirements are consistent through all states. These situations apply to state government Medicaid, and may not apply to private Medicaid style plans. This article addresses any potential issues with Medicaid Billing.

Subscriber/Patient Relationship
On eClaims, Medicaid requires that the patient and the subscriber be the same entity. In many cases a parent with one or more children receive Medicaid assistance. When this is the case, one parent or the other may be considered the person financially responsible, Medicaid does not want to see the parent on the eClaim as the subscriber.

To properly set this up in MacPractice, maintain the parent's record in the Primary/Secondary tab. In the patient tab of the child's record, set the patient's relationship to parent that has the Medicaid coverage as Child.

In the Medicaid insurance reference, set the plan type as Medicaid (MC) in the Claims tab, if there is no plan associated to the patient within MacPractice.

If there is a plan associated to the patient within MacPractice, set the plan type in the insurance reference > Plans tab > Coverage sub-tab.

Once these items are set as shown, any eClaim created for the patient will show the patient as the subscriber, as is required by Medicaid, and the claim will contain the subscriber ID as entered in the patient insurance record (Insurance sub-tab of the Patient tab of the Patients ability).

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