What Steps Should be taken to Verify a Patient Medicaid Eligibility?

Medicaid eligibility verification helps healthcare providers in submitting clean claims, thereby avoiding claim re-submission, reducing demographic-related denials, and increasing upfront collections. Verification done in time not only leads to improved medical billing but also paves the path for overall elevated patient satisfaction.

Medicaid eligibility verification process should ideally start before offering the clinical services and be undertaken with utmost care.

The following steps can ensure the reduction of eligibility-based denials for any healthcare provider billing team.

Verify a Patient Medicaid Eligibility

Verify a Patient Medicaid Eligibility

Transcribing Accurate Information: Asking the right questions to the patient by the front office staff goes a long way in getting the correct information. The staff must enter the correct information into the billing system from the patient’s Medicaid card as well as verify information through calling up Medicaid office. Transcribing correct information into the medical record of the patient is critical. Any hastily done verifications can result in data errors that may disrupt timely payments or even claims going unpaid, which can be detrimental for the practices and hospitals.

Checklist for Medicaid Eligibility Verification: The data in a patient’s electronic medical records can come handy for eligibility verification, including:

  1. Medicaid claims address and phone number
  2. Medicaid Policy Number
  3. Exact name of the insured, since it may not necessarily be of the patient
  4. Relationship of the patient with the insured
  5. Effective start date of the Medicaid policy
  6. Effective end date
  7. Whether the coverage is presently active

Thorough Understanding of Medicaid’s Mandatory and Optional Coverage: Medical practices cannot bill a patient for any supplementary charges post Medicaid adjudicating the claim, unlike with Medicare. So, the health care service providers must be aware of the mandatory and optional coverage offered by the patient’s insurance service (Medicaid). Medicaid programs could vary across states. A medical practice’s billing teams must contact directly the state’s Medicaid program to understand the exact coverage of the patient’s policies.

Some of the mandatory coverages include ambulance service, inpatient and outpatient hospital or clinic care, doctor services, rehabilitation facility care or short-term inpatient skilled nursing, x-ray and laboratory services, home healthcare (short term), and certain prescription drugs for those with no coverage from Medicare. The State Medicaid programs can choose to provide optional services like hearing tests and hearing aids, eye tests and glasses, preventive screening, dental care, chiropractic care, physical therapy, and others. Some of the services not covered by Medicaid include annual or routine physical checkups, missed appointments, cosmetic surgery, custodial care, and medical services available outside of the US.

Directly Contact Medicaid and the Patient: The healthcare providers and hospitals must contact Medicaid for eligibility verification and benefits data of patients and not to take information from patient’s card at face value. Insurance coverage changes even after a few weeks of the card being issued. Normally, there will be month on month coverage with Medicaid.

Finally, following up with the patient as often as needed for any concerns or questions regarding Medicaid information with the use of a patient portal, emails or calls becomes necessary for a seamless claim recovery experience. Professional medical billing services firms can help you check eligibility with ease. Consider getting professional help to streamline the process, and address revenue leakages.


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