Claims for Medicaid Beneficiaries Eligible for Medicare

This article is provided by the Michigan Department of Health & Human Services. Visit their website at www.michigan.gov/mdhhs.

Per Medical Services Administrations (MSA) policy bulletin MSA 18-50 effective for dates of service on and after January 1, 2019 Michigan Department of Health & Human Services (MDHHS) will begin to pay claims for Medicaid beneficiaries who are eligible and not enrolled with Medicare, this includes beneficiaries that are only partially Medicare enrolled (i.e. enrolled in Medicare Part A and not Medicare Part B). The claims will be paid as Medicaid primary, once the beneficiary obtains Medicare coverage Medicare should be billed and the Medicaid claim should be adjusted by the provider to reflect the primary payer processing. If claim adjustments are not performed by providers, then MDHHS Third Party Liability (TPL) will initiate claim voids.

Providers with further questions can contact provider support at Providersupport@Michigan.gov or 1-800-292-2550.