16 Del. Admin. Code § 14000-14670
Because other insurance is commonly available, the Federal Government as a way of saving taxpayers' monies, has required by law THAT Medicaid be a payor of last resort.
Because Medicaid is a payor of last resort, it is especially important to screen patients for the existence of other health insurance coverage. Keep in mind that other insurance will usually pay more for the incurred charges than Medicaid, hence it is beneficial to always inquire thoroughly.
Although the Medicaid Program attempts to collect this information when a recipient becomes eligible, additional efforts in this area at redetermination should not only increase provider's payments, but decrease the expenditures of taxpayers' monies.
The usual elements that a financial social worker will need to obtain are: name, address, policy number of the insurance company, as well as the policy holders name, address, Social Security number, employer number and effective dates of coverage.
Medicaid will only pay a designated amount (which is usually lower than the amount billed) no matter what the provider charges. This payment has to be accepted in full by the provider and the client cannot be billed for any balance. Providers agree to accept our payment as payment in full when they sign a contract to enroll in the Medicaid Program. Any violations should be referred to the Surveillance and Utilization Review unit.
Clients can report loss of coverage or a change in benefit directly to the TPL unit via phone call. This unit also investigates and verifies potential coverage for Medicaid recipients.
16 Del. Admin. Code § 14000-14670