Question:

I have a case where the hospital has a claim that needs to be submitted to Medicaid for payment.  However, since the hospital knows that there is a liable third party, they are refusing to submit the claim to Medicaid.  How can I force the hospital billing office to submit the claim for payment?  – FL Attorney

Answer:

In this instance, the provider has the right to go either way, so there is no real avenue to “force” a provider to bill Medicaid for services.  Under Medicaid’s provider agreement, the hospital has the right to bill all other insurers first, with Medicaid being the final payer.   On the other hand, Medicaid has the right to subrogate for payments made when a third party is responsible. 

Medicaid as Final Payer – Why the Provider can bill liable insurer: 

 FL Statute 409.907(3)(f) – Medicaid Provider Agreement

 (3)  The provider agreement developed by the agency, in addition to the requirements specified in subsections (1) and (2), shall require the provider to: Read the rest of this entry »