How To File A Medicaid Claim

Medicaid insurance is a program of the federal and state government to help low-income individuals and families cope with the costs of health care. Pregnant women, children, people with disabilities, and the elderly are among those that are given health coverage under the program.

Eligibility for Medicaid varies from state to state. However, each state must follow certain guidelines imposed by the government. It must be noted that poverty, on its own, does not guarantee eligibility for inclusion in the Medicaid program.

Who Administers Medicaid?

The federal agency that regulates and oversees all state Medicaid programs is the Centers for Medicare and Medicaid Services (CMS).

Once determined to be eligible, an individual or family can receive medical care from providers who are enrolled in the Medicaid program. These providers are the ones who bill Medicaid for services rendered.

Billing at the local or state level, so it is also at the state level that program administration is determined.

Can an Individual File a Medicaid Claim?

The question of how to file a Medicaid claim is one that can confuse both individuals and medical care providers.

Each state has its own application and claim forms. The application is submitted by the eligible individuals or families. In the case of minor children, these are normally submitted by their primary caregivers. In the absence of primary caregivers, state institutions or agencies may handle the application process.

As for the claim forms, this is ordinarily taken care of by the medical service providers or the health care providers, the ones who will submit the claims.

Individuals or families may only fill out and submit a Medicaid claim by themselves, under two circumstances:

1. if or when specific health services required by the patient are not covered by the health provider, or,
2. then the health care provider states that it does not submit claims to Medicaid

How Does the Submission Process Go?

If you are a non-provider, and are the actual patient eligible for Medicaid that is filing a claim, follow these basic steps:

1. Go to your local Medicaid office to get the appropriate claim forms. You might also try getting the forms online. There are states with websites that have sections for downloadable forms of many kinds. In case your state does not have such forms for download, you need to visit your local Medicaid office and fill out the forms yourself. If you are still too weak to do so, authorize a relative in your behalf to ask your local Medicaid office how to go about filing a claim. Remember that each state may have its own rules, so never assume a procedure. Always check it out.

2. If you are able to get a Medicaid claim form, you need to put in the correct service codes on the forms. Be careful about the service codes as they are the one that identify the exact type of treatment you are referring to for claiming. Correct service codes are fundamental to correctly process the Medicaid claim form.

3. When you are done filling up the form, you have four possibilities for submission:

a. Via snail mail - Make sure that you use certified or registered mail to avoid problems in mail handling losses.
b. Personal appearance and submission
c. Fax or email a signed copy - This depends on the facilities and requirements of your local Medicaid.
d. Online form submission - Verify if your state Medicaid has the capability for online form submission. This is the fastest and simplest form of claim submission, but not all states may be able to provide this method.

Addtional information on Medicaid topics can be located at: http://www.newyorkmedicaidapplication.com