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If one has a Medicare Advantage plan with New York Medicaid just added, how can the provider collect on the Medicaid portion when it is tied to an inactive Medicare Adv plan, not the current one?
How does one fix this error when the records appear correct on the Medicaid end, but on the provider end the Medicaid number is tied to an 2014 Medicare Advantage plan? The provider acts like he cannot bill Medicaid because it won't go through while it is tied to the old Medicare Advantage plan. The only thing that I can think of is 2014 might have been when my sister got accepted into the QMB program, which Medicaid also apparently pays for. However, the QMB has since been transferred to her current Medicare Advantage plan that she has had for years. Also, please note that my sister has only been going to this provider (specialist) for less than a year, so the older Advantage Plan was not even in their records, but only appeared when they attempted to bill Medicaid.
ejherm
When dealing with a Medicare Advantage (Medicare Adv) plan that has New York Medicaid recently added, and the Medicaid portion is linked to an inactive Medicare Adv plan, there are several steps to consider:
Dual-eligible Special Needs Plans (D-SNPs): These are Medicare Advantage Plans specifically designed for individuals enrolled in Medicare and Medicaid. D-SNPs typically require using in-network providers for Medicare services, and these providers should also accept Medicaid. Cost-sharing varies among plans, and some may offer zero cost-sharing for enrollees. D-SNP enrolment is voluntary, and it’s essential to verify that Medicaid covers Medicare cost-sharing, such as deductibles and copayments.
Medicaid Advantage Plus (MAP) Plans: For individuals with long-term care needs, MAP plans provide a “wrap-around” partial Medicaid benefit to enhance coordination between Medicare and Medicaid services. If you’re eligible, you can enroll by following these steps:
Call 1-800-MEDICARE (633-4227) and enroll in the MAP plan’s Medicare product. You may be instructed to call the MAP insurer directly for further enrollment.
Contact New York Medicaid Choice (the state’s managed care enrollment program) at 888-401-6582 to complete the Medicaid portion of enrollment into the MAP plan.
Original Medicare + Medicaid: Some individuals may prefer Original Medicare coverage because it provides greater flexibility in choosing providers. In this case, you can combine Original Medicare with a Medicare Part D plan and fee-for-service (FFS) Medicaid. Additionally, consider a Medicaid managed long-term care (MLTC) plan if you have long-term care needs.
Remember that each situation is unique, so it’s advisable to consult with a knowledgeable professional or contact your local Medicaid office for personalized guidance.
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