Friday, November 23, 2012

Medicaid Waiver: Even Though Smoky Mountain Center LME States they Do Not Need Medicare information to Bill Medicaid, Billing Entities State the Opposite

When, if ever, will these travails every end? Will providers ever have the seamless billing BACK that they had when Medicare wrapped around to Medicaid automatically----PRIOR to this ridiculous Medicaid Waiver?  Though Smoky Mountain Center LME personnel indicate that they do not 'need' the EOB's or billing information from Medicare as 'they trust us' (the providers)-----the billing entities cannot bill SMC LME for the wrap-around Medicaid services without having the EOB's.

This is what my biller has advised me:

"....I can only produce 2nd claims electronically by putting in the primary/Medicare information on what they paid, so technically SMC does not need the physical paper EOB but do need the information to appear on the electronic submission.   My system will not produce a 2nd claim to any carrier without the primary information keyed in...."


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