Medicaid Billing Information

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To contact our Billing Department, please call us toll free at (866) 776-5907 and press 2.

Medicaid is medical assistance for those people who cannot afford their own health care. Medicaid claims can only be filed after all other third-party resources have been exhausted. Patients should be asked at the time of service if there is other coverage, such as Medicare, Medicaid HMO, or private insurance. When applicable, any Medicare, private insurance, or managed care (HMO) information should also be provided. Medicaid is also for persons that have applied for social security disability, but have not met the 18th month waiting period for Medicare eligibility.

When Completing a Medicaid Billing Request:

Indicate with a mark the “Medicaid” billing option on the test request form. Each Medicaid agency has its own rules and regulations governing laboratory billing practices. Filing requirements are specific to each state. Please include:

  • Patient’s complete name as it appears on the Medicaid/Medi-Cal card
  • Patient’s gender
  • Patient’s date of birth
  • Specimen collection date and time
  • Patient’s address
  • Patient’s telephone number
  • Patient’s status: inpatient, outpatient, or nonpatient
  • Ordering physician’s last and first name
  • Ordering physician’s signature; necessary only in states where required
  • Treating/PCP/PMP/clinician’s first and last name where required
  • Provider/authorization number—where required
  • List all applicable ICD-9-CM diagnosis codes to their highest level of specificity
  • Complete Medicaid/Medi-Cal number and state as it appears on the Medicaid card. Indicate primary or secondary information
  • If Medicare is primary and an Advance Beneficiary Notice (ABN) is needed, the patient should sign an ABN form when the physician believes that Medicare is likely to deny payment for the identified services.

Note: If Medicaid denies payment for non-covered services or eligibility reasons, the patient may be responsible for the payment. Medicaid is always the last source of payment.

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