Medicaid
What Plan Code is Straight Medicaid?
229
What does PMAP stand for?
Prepaid Medical Assistance Program
Where do you find the Minnesota Health Care Program Plan Code Grid?
It is linked under the Insurance Plan Code Guide or under the Medicaid Plan Code's
What out of State Medicaid do we currently accept?
Iowa and Wisconsin
What does Limited Benefits mean?
The insurance covers the service but has limits (such as a maximum number of visits per year). Once the limit is reached, additional visits may not be covered.
True or False: There should always be a group name or group number on Medicaid
False
What are some health plans that offer PMAP programs?
Medica, Ucare, Blue Plus, HealthPartners
Which Program Code(s) do we NOT add?
AC and GRH
What status should Out of State Medicaid plans be marked?
Network Limitations
What does Non-Covered Services mean?
The patient's insurance does not cover the service, so the provider will not be reimbursed, and the patient may be responsible for the cost.
What do you always need to be checking for when a patient has Medicaid?
Restrictions
True or False: a Medicaid and Pmap can be billed together in the same filing order
False
What Program Code is FP? and What Plan Code would it go under?
Medicaid MN Family Planning, 470
What type of note do we need to leave if a patient has WI Medicaid on file and they are marked as Network Limitations?
Guarantor Note
What is the Smartphrase used when entered an FYI for a Restricted patient?
.INSURANCERESTRICTION
What plan is used for Medicaid MN Care?
1587
Following SR-001 policy, when should a Medicaid coverage begin when a Pmap coverage terminates to ensure accurate billing and claims processing?
One day after the PMAP coverage terminates
What Program Code is HH? What Plan Code would it go under?
Medicaid MN HH MH Only, 1470
What does a Closed Access out of Network mean?
The patient has opted to receive services from an out-of-network provider, and their insurance plan has no out-of-network benefits.
What is a MEC Policy? What would this be marked?
Minimum Essential Coverage policy; Limited Benefits
If a patient is Restricted, what do you need to enter?
an FYI
What are some WI PMAP plans we offer?
UHC WI MA, Security Health Badger Care, Group Health Eau Claire MA, MHS Medical MA
If the patient has Program Code EH along with a straight Medicaid program code, which program could would you enter?
Straight Medicaid
Out of State Medicaid is out of network except for what?
Emergencies
What Trumps Network Limitations?
Limited benefits