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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.11 Medicare and Medicaid Dual Eligibility : 4.11.2 Medicare Part B Crossovers

The following qualify as Medicare Part B crossover claims: QMB, MQMB, and client TPs 13 or 14, with base plan 10, and category R.
If the provider has not accepted Medicare assignment, the provider may receive payment of the Medicare deductible or coinsurance according to current guidelines on behalf of the QMB, MQMB, client TPs 13 or 14, base plan 10, and category R client. If the provider has collected money from the client and also received reimbursement from TMHP, the provider is required to refund the client’s money.
The Social Security Act requires that Medicaid payment for physician services under Medicare Part B be made on an assignment-related basis.
If Medicaid does not reimburse all or a part of the deductible or coinsurance, the provider is not allowed to bill the client.
Refer to:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.