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Once Medicare has "adjudicated" the bill, MediCal's payment will be based on their policy and the patient's eligibility on the date of service.

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โˆ™ 2011-03-03 15:53:11
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Q: Patient has Medicare primary and medi cal secondary provider bills Medicare knowing Medicare contract is suspended or pending who then pays claim?
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Related questions

Can your husbands company require Medicare to be your primary provider?

they can't actually "require" it but any insurance can contract with Medicare to be secondary, provided both parties agree


Does Texas Medicaid pay a non par provider as secondary to a par provider for Medicare?

Yes


Can Secondary Insurance not pay anything on claim if Medicare pays more on claim than they would if they were primary?

Yes, If medicare pays more than the secondary insurance allows for a charge, the secondary insurance pays nothing. The balance is written off to a contractual allowance that is agreed upon between the provider of service and the insurance company via contract.


Does medicare part a pay the difference after Blue Cross which is primary carrier paid most of the claim for skilled nursing facility I have a 290 balance due the nursing facility?

Medicare does offer coverage for skilled nursing facilties. In order to find out if Medicare will pay as your secondary, the provider needs to submit it to Medicare. This statement is from the Meidcare.gov website: Medicare providers must submit claims (bills) to Medicare for you, whether Medicare is your primary or secondary insurer. For Medicare to process a claim as a secondary payer, the provider must give your primary insurance information to Medicare. You may also consider calling 1-800-Medicare for information about secondary coverage. If you do, remember from Nov 15th to Dec 31st is a busy time for Medicare so it may be difficult to reach them. One more hint to save some frustration: If BlueCross BlueShield has already paid the amount they were supposed to pay, calling them won't really help you because their job is done. Now the remaining bill is between the provider and Medicare.


If I cancel a primary phone line will it cancel my plan including my secondary phone?

This depends on the terms of your provider's contract. Contact you cell phone provider for details.


Can you see a doctor without a referal if you have Medicare?

Yes. Original Medicare does not require you to obtain a referral before seeing a provider, but it does expect you to see a Medicare provider.


What term explains Medicare payments and denials?

The EOB (Explanation of Benefits) is what explains Medicare's payments and denials. Sometimes it is referred to as an EOP (Explanation of Payment). This document will show all items filed on a particular claim for a particular provider. It will show which items were covered or noncovered and why, which items were denied and why, and which items were paid. It will also show the patient's responsibility as far as deductible and coinsurance goes. If the patient has a Medicare supplement or just a secondary plan and Medicare is aware who you have chosen, they will "crossover" the claim to the secondary. This means they will automatically send a notification to the secondary payor to let them know how much Medicare allowed (the total amount the provider should receive from Medicare, other insurance companies and the patient), and how much is being left to the patient/secondary.


Can a Medicare participating provider decide to accept assignment on a claim-by-claim basis?

No. This is false. - A Medicare participating provider can not decide to accept assignment on a claim-by-claim basis. The provider registers with Medicare as a provider that will accept assignment and must accept assignment on all patients.


How do you obtain a Medicare number?

The patient obtains a Medicare number by being Medicare eligible. The provider obtains the Medicare number from the patient.


What does it mean when a provider accepts assignment of benefits in relation to Medicare?

It means that the provider agrees to bill Medicare for treatment and accept Medicare as payment in full (except for co-pays and deductibles).


Is it illegal for a provider to bill a Medicare patient for a bill when Medicare has not paid their share?

Yes


Will Medicare pay for your mother's bed assist rails?

Consult your mother's insurance or Medicare provider.

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