The practice of an MCO or Medicaid charging a medical insurance provider is backwards. It's absolutely the obligation of the commercial insurance provider to make the preliminary payment, to ensure that insurance coverage claims are not delayed, which is the case when Medicaid or a Medicaid MCO does the initial billing.
It only makes sense that insurance providers should be required to handle claims quickly and make timely payments regardless of whether the claims are electronic or on paper. So long as an acceptable timeframe is utilized, an MCO or a state Medicaid agency ought to have the right to identify alternative claim processing approaches in order to maintain the integrity, and consequently the speed, of the entire process. Eventually, this implies that federal laws are complied with, timetables are developed on retrospective recoveries by state Medicaid agencies, and Medicaid funds aren't left in a state of limbo... Read More
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