About LASHUNDA Expertise Billing,Claims, and resolutions to the following insurance agencies: Medicare, Medicaid, Coordination of Benefits, Most Managed Care such as HMO's, PPO's, Medicare Advantage Plans, Governmental Agencies such as Work Comp and Veteran's Administration. I would like questions that are in regards to Billing and Collections from Insurance Companies. I can also accept some questions regarding accounts sent to Medical Collections. Please be advised that I reside in Texas and most of my knowledge is based on how it works in Texas.
Experience I have worked in the Medical field for 15 years. I currently help to coordinate contracts for a physician group in Texas. I am extremely good with resolving issues with commerical insurance companies. I'm an expert in coordination of benefits between Medicare and Commercial insurance companies.
Question Hi. I have a Medi-medi patient in California treating with a chiropractor. I have never billed before for a Medi-Medi patient. After we bill Medicare, what is the next step? Who do we bill? How can I find out? Is there a change effective 06/30/09 re: medi-Medi patients that would affects their payments? Thank you.
Answer Hi Corina. Thanks for the question. I don't know anything about Medi-Medi in California. How it works in Texas is the Medicare Advantage Plans (MAPs) have worked out an agreement with the state of Texas to pay the portion that would be due from medicaid. Medicaid then sends the MAPs a check for paying the claims. Usually MAPs will pay what they are responsible for and then some MAPS will send a separate explanation of benefits for the portion that is due from Medicaid.
You probably should find out which MAPs in your state has an agreement with the state of California to make payments in place of Medicaid. Once you find that out than you shouldn't bill anyone because the MAP will pay both portions.
What I've found is that not all MAPs has an agreement with the state of Texas and if the MAP doesn't have an agreement with the state you are out of luck. Medicaid in Texas will not pay secondary to MAPs that do not have an agreement with the state. I'm not sure if it works that way in California.
