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Medical Coding Exam Prep

Category - Free Medical Coding Test Prep

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Sheila took her 5-year-old daughter to the pediatrician's office for an annual well-child exam. She has a commercial Blue-Cross Blue-Shield insurance plan, through her work, which covers her daughter. Sheila also has Medicaid coverage on her daughter, due to her low-income status. Which one of her insurances is billed for the well-child exam?

  1. You bill Blue-Cross Blue-Shield first and Medicaid second
  2. You bill Medicaid only
  3. You bill Blue-Cross Blue-Shield only
  4. You bill Medicaid first and Blue-Cross Blue-Shield second
Explanation

Answer: A - You bill Blue-Cross Blue-Shield first as the primary payer, and send a secondary claim to Medicaid, once the primary insurance has paid. Medicaid is always the payer of last resort, and as such is always billed after a commercial insurance processes the claim.

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