For facility based providers, how are you handling out of state Medicaid patient accounts? Do you become participating providers for the out of state Medicaid plans, write these services off, or bill the patient? I have ran into an increase of patients presenting to the ER with a variety of out of state Medicaid plans. These states are not boarding states to where we are located, and the charge balances are usually small therefore the incentive of completing the credentialing process is lacking. I have learned through my processes, some states do not allow you to backdate or request a retro-effective date on a credentialing application, so your charges are still not be covered if you completed the enrollment process. We have also invested time in the past to complete the credentialing process, only to have it take so long our claims were denied for timely filing. Then there is the managed care options in each state that you may have to enroll with once you become a provider for the state plan. Is there an industry standard for handling out of state Medicaid balances?
Thanks in advance!
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Penny Shepherd
Billing Office Manager
Professional Medical Management/Iowa Radiology
West Des Moines IA
(515) 226-7426
Professional Medical Management
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