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Filing claims

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  • Filing claims

    Does anyone know how to file eyeglass claims to Medicaid when they are secondary to another insurance? I'm also having trouble getting paid for RGPs for a keratoconus patient with BCBSFL. Thanks

  • #2
    When medicaid is secondary, you can not file til after you have received the Remittance advice showing the payment from the first payer on the exam/glasses. If the primary payer has not paid as much as your state medicaid, then you should file the claim with a copy of the RA attached, and they should reimburse you for up to the state regular rates. They will not cover anything that is not typically covered either. So for the state of Indiana, they won't pay for poly, even for children.

    For your Keratoconus patient, you need to make sure you are using the correct diagnostic code and fit/eval code (92072). Some insurances also require a medically necessary waiver/form sent in/
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland