Georgia Medicaid Paper Claims and TPL

I recently went to a Georgia Medicaid Third Party Liability (TPL, or Medicaid Secondary Claims)

presentation for any updates. Thought I would pass along the information:

Here is the slide presentation if you would like to view:

https://www.mmis.georgia.gov/portal/portals/0/staticcontent/public/all/notices/2014%20tpl%20presentation%2024‐09‐2014%20003939.pdf

However, the slide presentation shows you how to send Secondary Medicaid claims on paper, which

will not be allowed as of May 1st. Any paper claims will be shredded starting May 1st. With the end of paper claims with Medicaid, this also means Medicaid will be running more possible audits in the future.

On TPL claims, make sure the primary insurance is entered correctly into the online claim. Selections for insurance type should be one of the following: BCBS, Commerical Insurance or Medicare only. If Medicaid does not have the correct primary payer, you must file a DMA‐410 form to update this information if the parent has not done so with DFCS.

Medicaid is performing pay and chase with claims, therefore sometimes going after the insurance companies to recoup money they did not pay originally to the provider.

If an insurance company reprocesses a claim after you have filed with Medicaid, you must file a DMA‐501 form to adjust this information.

Remember that you have 12 months from the month of service to file a TPL claim with Medicaid. If you receive an error with any claim that did meet timely filing standards, call Medicaid for help.

When filing a secondary claim, make sure you put the correct error code for the processing reason of the primary. Other additional detail information should always be put under each claim line item, not as a header.

A list of error codes can be found here:

http://www.wpc‐edi.com/reference/codelists/healthcare/claim‐adjustment‐reason‐codes/

DFCS is now updating eligibility weekly, therefore a patient's insurance can change anytime during the month.

There is also rumor that starting in June, HP Medicaid will be processing the CMO applications instead. I'm looking forward to this if this is the case due to the slow process of getting providers into network with the CMOs.

There is a manual for Secondary Claims: https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/HANDBOOKS/Medicaid%20Secondary%20Claims%20User%20Guide%2023‐09‐2014%20215517.pdf

There will be updates as well for the next CIS Manual in April, so keep an eye out for that as well.

Medicaid's next fair is said to be scheduled May 6 in Gwinnett. This is a great time to bring in any problem claims to work, meet reps for your area for not only Medicaid but CMOs, and find out upcoming changes to DCH.