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NO MEDICAID BENEFICIARY COULD BE BILLED. IS THAT SO?
ASK AN EXPERT

Question: I am a New Jersey provider. Can I bill a Medicaid beneficiary for denied services?

Answer: Medicaid participating providers are prohibited from billing Medicaid beneficiaries for any amount, except for these conditions (see Newsletter Vol 11, #60): 

  • Services are not covered and the beneficiary elected to receive the services with the knowledge that they were not covered. The beneficiary must agree in writing to be responsible for payment before the date of service.
  • A third party made a payment directly to the beneficiary. 
  • The beneficiary is not eligible for Medicaid on the service date. 

This policy can be found in Chapter 10-49 of the Administrative Manual. To access Chapter 10-49, click on the State DMAHS link on the home page or request a copy of Chapter 10-49 by contracting the Molina hotline at (800) 776-6334.

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Insights
May 2018