TMPPM 2009 > Provider Information > Client Eligibility > Medicare and Medicaid Dual Eligibility

4.8.3 Clients Without QMB/MQMB Status

Medicare is primary to Medicaid, and providers must bill Medicare first for their claims. Medicaid's responsibility for coinsurance and/or deductibles is determined in accordance with the Medicaid benefits and limitations including the 30-day spell of illness. TMHP denies claims if the client's coverage reflects Medicare Part A coverage and Medicare has not been billed first.

Providers must check the client's Medicare card for Part A coverage before billing Texas Medicaid.

Refer to: "Medicare Crossover Reimbursement" .