Exploring Alternative Routes for Getting Paid from Indiana Medicaid Program
2021 E&M Changes
Indiana Medicaid Program offers medical benefits to low-income individuals without medical Insurance or adequate medical Insurance. In cases where the provider has more than one service location, there might be an issue associated with claim submission. However, it leads to neither payment nor denial of the Primary Claims submitted to Indiana Medicaid or result in the team presenting the same claim multiple times.
This article describes how the MBW accounts receivable and calling team worked to fix the problem in submitting the primary claims to Indiana Medicaid by looking for an alternative way to submit the claims, thereby preventing timely filing issues and obtaining payment duly.
Following Up on submitted claims:
The client had previously used Payer ID #00711 to submit the primary claims to Indiana Medicaid electronically. But the client did not receive either payment or denial from the Insurance. To get an update on these claims, our AR Calling team contacted Indiana Medicaid. Unfortunately, the Insurance was unable to provide the claim status. In addition, the Billing Provider NPI was registered with Multiple Service Locations that were not linked with either the Taxonomy Code or the registered Zip Code.
Clean Credentialing:
To knock off any issue that might arise due to errors in Credentialing, we escalated and fixed minor credentialing matters. Following which we resubmitted the claims and followed up with Insurance accordingly. This time the Insurance’s response denoted no claims on file and suggested resubmitting the claims through Payer ID HP. But HP is not a valid Payer ID in terms of Practice Clearing House Gateway. So, we escalated the issue to the client and again got the response to resubmit the claims stating the problem being fixed.
Online Submission:
We submitted few claims through the Indiana Web portal and got processed and paid. So, we notified the client of the Online Submission with Paid Claims reference and requested approval to submit all the claims through the Indiana Web portal. Although we did not get approval, the online submission method helped us clear a part of the pending revenue.
Proper Practice Setting
After continuous monitoring through Kareo support, we established that claims submitted electronically to Indiana Medicaid were landing in a different practice. Although this was not the issue in focus, it helped fix few practice configuration errors with Kareo. Meanwhile, the Medicaid EDI department reported that they could not process the claims as the Billing NPI pointed to Multiple Locations. Therefore, as per Medicaid’s suggestion, we submitted a Default Agreement Form found in the web portal to link all the multiple service location addresses under a default registered address
Conclusion
Eventually, we got approval from the Client for Online Submission through the Indiana Medicaid Web portal as the claims were nearing the timely filing limit of 365 days. So, we submitted all the Outstanding Indiana Medicaid Claims through Web Portal and got processed and paid. Then, we continued working on the same methodology for submitting claims to Indiana Medicaid until the Default Agreement Form to link all the Multiple Service Location addresses under the Registered Address was approved.
Overall, we submitted around 160 claims – with the value of $28 K and got paid for $5 K within a week. In addition, AR of $28K, which remained unaddressed for over a year, was collected simultaneously.
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