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Zero-Based Claims Can Be Counted

What are zero-pay claims and are these counted as Medicaid patient encounters?

Yes, as long as the service was provided to an individual enrolled in Medicaid, zero-pay claims may include:

• Claims denied because the Medicaid beneficiary has maxed out the service limit

• Claims denied because the services weren’t covered under the State’s Medicaid program

• Claims paid at $0 because another payer’s payment exceeded the Medicaid payment Claims denied because they
   were not submitted timely

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