Medicaid Claims Processing

Medicaid is a state operated health insurance program that is funded by the federal government. It is intended for people who belong to the low-income level set by the government. These groups of people usually cannot afford health insurance, or may have difficulty getting medical services due to their meager income.

For individuals who have qualified for Medicaid benefits, they typically make claims for reimbursements which they submit to the local Medicaid office. Commonly covered by Medicaid are medical expenses that may include doctor consultations or visits, emergency room services, and prescriptions. A person may submit the Medicaid claims for processing or it can be done for them by the medical provider. An individual usually submits the claims for reimbursement if the medical provider was not able to submit the Medicaid claims for them.

A good number of physicians and specialists have complained of delays in payment and other difficulties when making reimbursement claims. One way the government has tried to address this is to step up Medicaid reimbursement rates to encourage the involvement of physicians in Medicaid.

For people who will submit their own Medicaid claims for processing, they must get in touch first with their local Medicaid office. Medicaid offices contact information can be found in the website of The National Association of State Medicaid Directors. It is advised to get in touch with the individual’s local or state Medicaid office since some states have different processes when making Medicaid claims. They should ask what form they should use for Medicaid claims processing and how the procedures goes exactly.

An individual fills up the Medicaid claims form with necessary information such as their full name, address, date of birth, Medicaid number and Social Security number. Also needed are the medical provider’s identification and service code which corresponds to the kind of medical service the individual obtained and wants to reimburse.

Typically required for Medicaid claims processing are the receipts for all the medical expenses and services that an individual wants to reimburse. The receipts should precisely include important information such as the cost, the medical provider, and the kind of service or product that was given. Medicaid reimbursements usually cover prescription medicines, doctor visits, medical equipment, specialist services and mental health services.

After completing the Medicaid claims processing form, it may be sent together with the corresponding receipts and other necessary documentation by mail to the address listed on the claim form. These may also be faxed to a number that is also found on the form. The state’s Medicaid claim processing group will then review the claims submitted by the individual and establish if it will be reimbursed or not. They will check if the information on the form is complete and correct. If they find any errors or there are missing information, they will send it back to the person who sent it with the reasons why they did not process the Medicaid claim. The individual may rectify the errors or fill up the missing information and then resubmit the Medicaid claims form.