When a provider accepts a Medicaid beneficiary as a patient, the provider agrees to bill Medicaid for services provided. Similarly, in the case of a Medicaid managed care or Family Health Plus (FHPlus) enrollee, the beneficiary’s managed care plan for services covered by the contract. The provider is prohibited from requesting any monetary compensation from the beneficiary, or their responsible relative, except for any applicable Medicaid co-payments.
A provider may charge a Medicaid beneficiary, including a Medicaid or FHPlus beneficiary enrolled in a managed care plan, only when both parties have agreed prior to the rendering of the service that the beneficiary is being seen as a private pay patient (in that case claim must not be sent to Medicaid). This agreement must be mutual and voluntary. It is suggested that providers keep the beneficiary’s signed consent to be seen as a private pay patient on file.
If, for example, a provider sees a beneficiary, and advises them that their Medicaid card or health plan card is valid, eligibility exists for the date of service and treats the individual, the provider may not change their mind and bill the beneficiary for that service or any part of that service.