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2012 Texas Medicaid Provider Procedures Manual

Ambulance Services Handbook : 2. Ambulance Services : 2.4 Claims Filing and Reimbursement : 2.4.3 Medicare and Medicaid Coverage

Medicaid is the secondary payor to other health insurance sources, including Medicare. Ambulance claims for Medicaid and Medicare Part B claims must be filed with Medicare first.
Qualified Medicare Beneficiaries (QMBs) are not eligible for Medicaid benefits. Texas Medicaid is only required to pay for coinsurance or deductibles for QMBs. Therefore, providers should not request prior authorization for ambulance services for QMB clients.
MQMBs are eligible for all Medicaid benefits including ambulance transports. The provider should simultaneously request prior authorization for the nonemergency transport from TMHP for the MQMB client in the event the request is denied by Medicare.
Refer to:
Subsection 4.11, “Medicare and Medicaid Dual Eligibility” in Section 4, “Client Eligibility” (Vol. 1, General Information).

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