What’s the Difference Between Managed Medicaid and Traditional Medicaid?
Managed Medicaid and traditional Medicaid are two different systems of providing health care services to members of the program, though both are funded by the federal government. Managed Medicaid is a service that is administered by private companies and has been designed to improve the quality of care and reduce costs associated with the Medicaid program. Traditional Medicaid is managed directly by the state and keeps its costs in check by having budget restrictions and staying within allocated funds.
When looking at how these two systems differ, it’s important to consider both the differences in how they are administered and how they are used to bill for services. In the case of managed Medicaid, private companies have the flexibility to design their own policies and procedures to manage the system more efficiently and cut costs.
These companies can also provide additional services that are not covered under the traditional Medicaid system. Examples of such services include more comprehensive coverage for long-term care or mental health care, and managed care networks that provide access to a wider variety of healthcare providers. This gives members more choices in their medical care, and can lead to better health outcomes.
On the billing side of things, healthcare providers should take note of the many different billing codes that come with managed Medicaid. In general, managed care companies use electronic billing systems, as opposed to traditional Medicaid’s paper billing system, so it’s important for providers to be knowledgeable about the various codes associated with managed Medicaid, as well as the billing requirements that accompany them.
In addition, providers should be aware of any payment restrictions or delays that may be imposed by the managed care company. The managed care companies generally require prior authorization for certain services, and they often have assessment processes in place to determine medical necessity for certain services. All of this can lead to extra paperwork for providers and potentially longer wait times for payment.
In the end, the key difference between managed Medicaid and traditional Medicaid is the way these two systems are managed and how they bill for services. Managed Medicaid offers some significant cost-saving opportunities for providers, but they have to be familiar with the distinct policies, procedures, and billing codes associated with the program.