How to file Medicare/Medicaid claim – cms 1500 instructions
If medical services are provided to a client who is entitled to Medicare under the Social Security Act and also to Medicaid benefits, it is necessary that you file a claim with Medicare first. After you receive payment from Medicare, you may file a claim to Medicaid for reimbursement consideration. Each performing provider’s services must be billed on a separate claim form to Medicare in order to file a Medicare/Medicaid related claim to EDS.
In order to submit a Medicare/Medicaid claim to EDS, you must submit an original CMS-1500 claim with the following fields altered from your Medicare claim:
• Field 1a – complete this field with the client’s identification number;
• Field 24J – complete this field with the performing provider’s NPI or Atypical number;
• Field 29 – do not enter the Medicare Paid Amount. Enter only the total amount of funds received from third party insurance sources, other than Medicare; and,
• Field 31 – each claim must be signed with an original black ink signature;
• Field 33a – complete this field with the billing provider’s NPI or Atypical number.
You must include a copy of the Medicare EOMB to the claim with the client’s name circled. Each Medicare/Medicaid client listed on the EOMB must have a separate claim filed with an EOMB included with their claim form.
Any charges denied by Medicare will not be paid by Medicaid with the exception of:
those services not covered by medicare but covered by Medicaid; or
services covered by both Medicare and Medicaid but with different limits or criteria. In these instances Medicaid will determine coverage on the basis of its own policy.
You must include a copy of the Medicare EOMB to the claim with the client’s name circled. Each Medicare/Medicaid client listed on the EOMB must have a separate claim filed with an EOMB included with his or her claim form. Each performing provider’s services must be billed on a separate claim form with a maximum of six lines and no double details in one box.