When submitting a Medicaid claim for a patient who has primary and secondary insurance, which item should be attached with the Medicaid claim?

When submitting a Medicaid claim for a patient who has primary and secondary insurance, which item should be attached with the Medicaid claim?

• A. Remittance advice from the primary insurance along with the Medicaid claim
• B. Copy of the patient’s driver’s license
• C. Referral from the primary care provider
• D. Authorization from the secondary payer

Answer: (A)

When a patient has both primary and secondary insurance, Medicaid pays after the primary insurer has processed the claim. To determine Medicaid’s portion accurately, you attach the primary insurer’s remittance advice (or explanation of benefits) to the Medicaid claim. The remittance advice shows exactly what the primary payer covered, what portion the patient is responsible for, any adjustments or denials, and the allowed amounts. This information lets Medicaid coordinate benefits correctly and calculate any remaining amount payable, avoiding mispayments or delays. Other items listed don’t provide the necessary coordination information. A driver’s license isn’t relevant to claim processing, a referral isn’t required for submitting a Medicaid claim, and obtaining authorization from the secondary payer isn’t the standard document needed to process a Medicaid claim in a primary/secondary scenario.

When a patient has both primary and secondary insurance, Medicaid pays after the primary insurer has processed the claim. To determine Medicaid’s portion accurately, you attach the primary insurer’s remittance advice (or explanation of benefits) to the Medicaid claim. The remittance advice shows exactly what the primary payer covered, what portion the patient is responsible for, any adjustments or denials, and the allowed amounts. This information lets Medicaid coordinate benefits correctly and calculate any remaining amount payable, avoiding mispayments or delays.

Other items listed don’t provide the necessary coordination information. A driver’s license isn’t relevant to claim processing, a referral isn’t required for submitting a Medicaid claim, and obtaining authorization from the secondary payer isn’t the standard document needed to process a Medicaid claim in a primary/secondary scenario.