Enrollment in Medicaid plans of Medicaid members you treat

April 29, 2016

When hosting a Medicaid member from another Blue plan, if you are not enrolled in the member?s Medicaid plan, you could have experienced a claim denial. When claims are submitted by unenrolled providers, claims are denied until enrollment is completed.

New denial code

Effective April 15, 2016, when you submit a claim for an out-of-area Medicaid member, you will receive the new denial code "E1099" if you are not enrolled in that member's Medicaid program. The E1099 denial code will notify you that your claim has been denied due to your lack of enrollment in the Medicaid program of that out-of-area Medicaid member, and it will inform you to enroll in that member?s Medicaid program.

We encourage you to verify benefits and eligibility prior to rendering services. If the service you provide isn?t eligible for reimbursement, you will not be reimbursed. In this circumstance, you will be permitted to bill the Medicaid member only for non-covered Medicaid services if you obtained written approval from the member before the service was rendered.