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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.11 Medicare and Medicaid Dual Eligibility : 4.11.3 Clients Without QMB or MQMB Status

Medicare is primary to Medicaid, and providers must bill Medicare first for their claims. Medicaid’s responsibility for coinsurance and 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:
Subsection 2.6, “Medicare Crossover Claim Reimbursement” in Section 2, “Texas Medicaid Fee-for-Service Reimbursement” (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.