About 78% of Medicaid beneficiaries are enrolled in comprehensive managed care organizations, so most Medicaid claims are adjudicated by a commercial insurer with its own rules — not by the state. Practices that bill "Medicaid" as one payer are billing a dozen.
Medicaid claims go to the right payer, in the right order, inside the right window.
At a glance
Step 1
Bill the plan that actually adjudicates rather than the program on the card
Step 2
Track filing windows per plan, which are frequently shorter than commercial
Step 3
Verify eligibility every visit, because Medicaid coverage churns monthly
Step 4
Sequence Medicaid last, since it is the payer of last resort and enforces that
What we actually do
- Bill the plan that actually adjudicates rather than the program on the card
- Track filing windows per plan, which are frequently shorter than commercial
- Verify eligibility every visit, because Medicaid coverage churns monthly
- Sequence Medicaid last, since it is the payer of last resort and enforces that
What this fixes
- One internal Medicaid rule applied to plans that each set their own
- Claims denied for sequencing rather than for coverage
- Filing deadlines missed because the commercial window was assumed
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at how this runs today and where it leaks.
Scope
A written scope and price before any work starts.
Transition
We take it over without a gap in submission.
Report
The same six numbers every month, so you can see it working.
Medicaid Billing — Frequently Asked Questions
Why is Medicaid billing treated separately?
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Because it is not one payer. The program name, the managed care structure, and the filing window all change at the state line, and often within a state.
How is medicaid billing priced?
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It is included in ongoing revenue cycle management, which is priced as a percentage of collections banded by practice size — or as a flat monthly fee in states that do not permit percentage compensation of a billing company. Front-end services are also available on their own, per occurrence, without a billing contract.
Do you guarantee a result from medicaid billing?
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No, and nobody honestly can. Coverage, adjudication, payment amounts and appeal outcomes are decided by the payer. What we commit to is the process and the six numbers reported every month, all of which you can reproduce from your own practice management system rather than take on trust.
Can we buy medicaid billing without moving all of our billing?
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Front-end services are sold per occurrence and stand alone. The back-end work is harder to separate — denial management without control of coding and submission means inheriting problems created upstream — but we will say plainly which parts make sense on their own rather than sell a partial engagement that cannot succeed.
Ready for books you can actually trust?
Book a free consultation and we will tell you what your revenue cycle needs and what it costs.
- Done-for-you
- Solo or group
- Nationwide
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