Traditional MedicareAdministrativeHigh impact
MAB2021070801
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pain Management·Provider Bulletin
Effective date
Aug 16, 2021
We identified it
Jun 20, 2026
Summary
Effective August 16, 2021, Medicare now covers Opioid Treatment Program (OTP) services and becomes the primary payer for dually eligible individuals, with Medicaid paying secondary. OTP providers must enroll in Medicare to continue receiving payment for services to patients with both Medicare and Medicaid coverage.
Action Required
By September 14, 2021: OTP providers must enroll in Medicare to receive payment for services to dually eligible individuals after August 16, 2021. Billing team must verify patient eligibility using PROMISe Eligibility Verification System before submitting claims and bill Medicare first, then Medicaid for cost-sharing. Claims for OTP services to dually eligible individuals will be denied if Medicare is not billed first.