TMPPM 2008 > Provider Information > Client Eligibility > Medicare/Medicaid Clients

4.8 Medicare/Medicaid Clients

When a service is a benefit of Medicare and Medicaid, and both programs cover the client, the claim must be filed with Medicare first. Additional Medicare/Medicaid coverage information is in the specific service sections. Providers do not file a claim to Medicaid until Medicare has dispositioned the claim. The payment received from Medicare and the coinsurance and/or deductible payment from Medicaid must be considered reimbursement in full.

Providers must accept Medicare assignment to receive coinsurance and deductible amounts from Medicaid on services provided to clients. If a provider has not accepted a Medicare assignment, the provider may receive payment of the Medicare deductible and coinsurance from TMHP on behalf of the QMB or MQMB client.

Providers accepting Medicare/Medicaid assignment cannot legally require the client to pay the Medicare coinsurance and/or deductible amounts.

If the Medicare intermediary is TrailBlazer, LLC, Palmetto, or Mutual of Omaha, the Medicaid portion is transferred to TMHP through a Coordination of Benefits Coordinator (COBC), if the claim was processed as assigned. This benefit allows providers to receive disposition from both carriers while only filing the claim once. Providers allow 60 days from the date of Medicare's disposition for a claim to be shown on the Medicaid R&S report. Claims totally denied by Medicare are not automatically transferred to TMHP. If the Medicare intermediary is a company other than those listed, the provider must send a paper copy of the intermediary's Remittance Advice or Remittance Notice to TMHP for payment of the coinsurance and/or deductibles.

Refer to: "Reimbursement Methodology" and "Claims Filing Instructions" .