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Filing a Claim with Medicaid


Updated September 18, 2013

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Filing a Claim with Medicaid - Become a Provider
Filing a Claim with Medicaid

In this article we will cover filing a claim with Medicaid.

Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that regulates and oversees all state Medicaid programs. Eligible recipients receive medical care from providers enrolled in the program, who then bill Medicaid for services. That billing takes place at a local level so every state may have nuances in how the program is administered.

Before You Can Bill You Have to Become a Provider

Providers must be licensed and accredited according to the specific laws and regulations that apply to the service offered. To get an idea whether the services you offer are covered and what you can expect to be reimbursed check this Kaiser Family Foundation site.

Prospective Medicaid providers must apply for and be enrolled in the Medicaid program, be assigned a provider number, and agree to certain conditions of participation before payment can be made for services rendered to Medicaid recipients. The effective date on the participation agreement is the earliest date a provider may begin billing for services. So check with your state.

Find out more about provider numbers.

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