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Caring for out-of-state members with Medicaid
December 20, 2019

This article is for all UB-04 billers, including billing agencies

We recommend that you always verify members' benefits and eligibility before rendering services. When providing care for an out-of-state member with a Medicaid policy, please review the Medicaid guidelines and billing requirements from the member’s home state before submitting claims to us. This will help prevent unnecessary delays and claim denials.

While Blue Cross Blue Shield of Massachusetts does not offer plans with Medicaid, we do work with our providers to serve members whose Medicaid benefits are administered by other Blue plans nationwide.

To learn more, see Caring for Blue Plan Medicaid Members.

Medicaid guidelines for Empire Blue Cross Blue Shield of New York

When filling out UB-04 claims for Empire members with Medicaid policies, in field Value Code 24, use the Medicaid rate code (example shown below). Note that this is not a dollar amount. The value code 24 rate code is required for claims processing.

You can find this Medicaid rate code, along with other specific guidelines for Empire Blue Cross Blue Shield of New York, online at New York’s Department of Health website.

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