Do Not Balance Bill Dual-Eligible Members
State regulation states that a health care professional or facility that provides Medicare Part A or Part B services cannot collect any deductible, coinsurance or copay amounts from Medicare/Medicaid dually-eligible individuals. (State Regulation 18 NYCRR Section 360-7.7)
Medicare and Medicaid payment, if any, must generally be accepted as payment in full.
If you provide health care services for EmblemHealth Medicare Advantage members that are dually-eligible, you must:
- Bill the Managing Entity as primary payer.
- Bill the state Medicaid plan as secondary payer.
- Accept the Medicaid payment as payment in full.
- Avoid collecting any cost-share from the member if he/she participates with their state Medicaid program.
- Notify the member, prior to giving care, if you do not accept the state Medicaid as payment in full.
For more information: