What is the coverage status for a patient with an old Medicaid fee for service card alongside a Caresource Medicaid HMO card?

In medical billing and insurance, understanding the hierarchy of coverage is critical. With a patient holding both an old Medicaid fee-for-service card and a CareSource Medicaid HMO card, the correct answer focuses on the current rules regarding Medicaid programs.

Typically, when a patient has both a traditional Medicaid card and a Medicaid Managed Care Organization (MCO) card, the MCO card is the one that applies. This is because Managed Care Organizations like CareSource provide a more structured approach to care and services, often being the primary provider for Medicaid services. The fee-for-service plan may still exist for some patients; however, when an individual has transitioned to an MCO, that plan usually supersedes other coverage.

Therefore, CareSource applies as it represents the patient's current coverage option. The old Medicaid card would not be the basis for billing or services since the MCO effectively takes precedence in providing coverage, making it the primary source for any claims or services rendered. This understanding of payer hierarchy is essential for Front Desk Patient Service Representatives in processing and coordinating patient services effectively.