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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.12 Filing Medicare Primary Claims

6.12
When a service is a benefit of both Medicare and Medicaid, the claim must be filed to Medicare first.
Providers should not file a claim with Medicaid until Medicare has dispositioned the claim unless the service is a Medicaid-only service.
Medicaid claims for Qualified Medicare Beneficiary (QMB) and Medicaid Qualified Medicare Beneficiary (MQMB) clients can be filed to Medicaid for consideration of coinsurance and deductible payment as follows:
Medicare primary claims filed to Medicare Administrative Contractors (MACs) may be transferred electronically to TMHP through a Coordination of Benefits Contractor (COBC).
Note:
Refer to:
Subsection 4.11, “Medicare and Medicaid Dual Eligibility” in “Section 4: Client Eligibility” (Vol. 1, General Information) for information about MQMBs and QMBs eligibility.

Texas Medicaid & Healthcare Partnership
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