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.