Third Party Liability

Federal regulations require Medicaid to be the "payer of last resort".  This means that all third party insurance carriers, inculding Medicare and private health insurance carriers, must be billed before Medicaid processes the claim.  Additionally, Providers must report any payments from third parties on claims filed for Medicaid payment.

Third Party Insurance Codes

Carrier Codes  

Coverage Codes

Third Party Liability Information Card 

Electronic Secondary  Billing for Medicare and Senior Replacement Plans

Please view billing instructions if using the Provider Electronic Solutions Software.  The appropriate Carrier Codes can be found in the table below.

 

Electronic Secondary Billing for Medicare and Senior Replacement Plans

To facilitate electronic billing and proper reimbursement for Medicare and Commercial Medicare Plans (Advantage/Replacement Plans) such as United Senior Care, Blue-Chip Medicare HMO, WellCare Advantage Plan the following fields are required:

• Loop 2320 Other Subscriber Information SBR09 - Must contain MA or MB as appropriate for the claim filing indictor
• Loop 2320 Claim Level Adjustments CAS segment - Must contain Deductible PR 1 or Coinsurance of PR 2
• Loop 2320 Coordination of Benefits (COB) Payer Paid Amount – Must contain the Amount Paid (other insurance paid amount)
• Loop 2330B Other Payer Name (Carrier Code) Segment NM109 Other Payer Primary Identifier – Must contain the appropriate carrier code, see below for a list: