02/09/2024

Billing UHC Community Plan-Deductible Coverage-QMB Patients

I have noticed that when billing united healthcare community plan and some medicare advantage there is a deductible. Of course these patients also have medicaid and medicaid will not pick up the deductible. Not sure what to do with these unpaid bills since we legally cannot bill the patients who have medicaid (in new york). Is this another instance where we have to treat for free? If we hold the claims then we get hit with timely filing. Please advise what to do with the QMB plans.

If a patient is dual eligible between Medicare and Medicaid, the secondary needs to cover balances up to the Medicaid allowable amount. If the patient has traditional Medicaid, the secondary claim will need to be added to ePaces to get partial reimbursement for the Medicare deductible. If the patient is enrolled in Medicaid MLTC, the correct managed care plan needs to be balance billed for the deductible from UnitedHealthcare. Claims should not be held because there is no guarantee that a patient will meet their deductible, and claims could exceed the timely filing limit with the primary insurance. Once the note is locked, the claim should be submitted to the insurance for reimbursement.