Best Practices in Medicaid Claims Processing

Medicaid form
 LPETTET/Getty Images

A popular topic on our site has been about Medicaid claim processing. And while we have covered this issue in the past, it is worth highlighting ways to make the claim process smoother, assure you get paid and avoid scrutiny.

Submit Electronically

Submit claims electronically.

Electronic claims process in one-third the time required for paper claims. Electronic submissions also reduce errors, prevent unnecessary claim denials, increase cash flow, and decrease costs. Electronic claims processing is:

  • Faster
    • Most electronically submitted claims process in one to two weeks. You submit claims, view claims status online, view remittance advice, request prior authorization, inquire about checks, maintain your Provider Profile and verify member eligibility. Claims are adjudicated in two hours or less.
  • Easier
    • You can easily submit all traditional Medicaid claims, including claims requiring attachments, using the Web.
  • More Accurate
    • Electronic claims help reduce keying errors. In addition, claims submitted on paper are often handwritten, which makes them less clear and harder to read.
  • Less Expensive
    • With electronic claim submission, provider staff members no longer spend their time printing and mailing forms - a costly process.

Other Tips

  • Include valid recipient identification numbers (RIDs) with all claim types.
  • Include a valid National Provider Identifier (NPI) with all claim types.
  • DO NOT use red ink - it disappears when claims are scanned.
  • Be sure Medicare, third-party liability (TPL), and Medicaid information is placed in the proper fields on UB-04 claims.
  • Submit proper invoices for manual pricing.
  • Make sure hand-written paper claims are legible and include full signatures.
  • Sign up for direct deposit of your Medicaid payments.
  • Familiarize yourself with the Medicaid Provider Handbook.
  • Review general billing instructions.
  • Review service-specific coverage and billing instructions.
  • Review billing instructions for Medicare Crossover Claims.
  • Establish your claim tracking system.
  • Track status of your initial claim submission.
    • Review your " Medicaid Claims In Process Over 30 Days" report.
  • Watch for notices about Returned, Rejected or Deleted Claims.
    • After you submit a claim, you may receive a notice telling you that your claim could not be entered and/or completely processed. Make corrections on the claim or complete a new claim and submit it within one year from the date of service.
    • "Deleted Medicaid Claim Report" - This report lists paper claims that were unable to be processed completely. The claims on this report were successfully entered, but certain problems with the claim prevent it from final processing. Deleted claims are not considered 'denied' claims; they are claims that must be corrected and reprocessed.
    • "Electronic Claim Activity Report" - This notice is for electronic claims. It includes both rejected and deleted claims. It is sent to your electronic submitter/clearinghouse.
  • Review your Medicaid Remittance Advice and follow up promptly.
  • Understand how to submit Claim Adjustment Requests.
  • Track your Claim Adjustment Requests.

While the payment system seems laborious (and well it is), you can avoid headaches by properly submitting and tracking your claims. We hope these best practices help.

Was this page helpful?