11/12/2021

Delays When Billing Medicare and Medicaid

in new york state, when i send medicare and than to medicaid. medicaid only pays deductible not met but is it only three months from date of service or when it was sent to medicaid? Thank you

New York State Medicaid will typically cover the deductible for services that were approved by Medicare. When Medicare processes a claim and applies it to the part B deductible, it is submitted automatically (autocrossing) so a provider does not have to submit a secondary claim to Medicaid for reimbursement of the patient responsibility.

In some cases, a provider may have to resubmit a claim if it is not paid within 30 days of the balance being autocrossed from Medicare, it can be resubmitted to Medicaid for payment.

For secondary claims, it is 90 days from the date that Medicare processed the claim. If there is some delay in submission, the claim can still be paid by Medicaid up to two years after the DOS, as long as the paper or electronic claim has a “delay reason code” specified to indicate why a claim was not submitted within 90 days of the date of Medicare’s processing.