Medicare and Medicaid

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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2011-03-03 15:53:11
2011-03-03 15:53:11

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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Related Questions

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

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.

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 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.

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.

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.

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

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.

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

you can do a general internet search or call your local Medicare intermediary and ask who a specific provider is they will never release the provider number over the phone and you cant get it any other way without being affiliated with the provider.

What provider receives reimbursement for Medicare directly from the fiscal intermediary? QIO - Quality Improvement Organization

If a provider accepts Medicare they have to accept a standardized supplement. They may not accept a Medicare Advantage or a Medicare Supplement Select plan.

Consult your mother's insurance or Medicare provider.

If you have medicare and you are a dependent on your spouses medical insurance policy then you would be primary under your spouse and Medicare would be secondary payor. There are a few circumstances where Medicare would be primary but very few (your spouse is covered under COBRA, the group is less than 20 members, or you have end stage renal disease.) Medicare is 99.99 % always secondary because it is a government program (much like Medicaid.) I hope this helps:) Evan

If you have a Medicare Supplement then the provider will bill Original Medicare first. At that time Medicare will pay the allowable amount and then return an explanation of benefits stating the beneficiary's portion. Based on the Medicare Supplement Plan that is in place (A-N) the Medicare Supplement will pay a portion or all of the remaining amount due. If they pay only a portion based on the plan (A-N), then according the plan guidelines, the beneficiary would pay any outstanding amount at that time. If a Medicare beneficiary is covered on a employer or retiree group plan and due to the size of the plan, the group plan is primary, then the group plan benefits will apply first and any amounts due by the Beneficiary will be billed to Medicare second. If it is a Medicare covered service, then Medicare will pay the remaining amount due as the secondary payor up to the amount allowed by Medicare. If the service is not allowed by Medicare, than the beneficiary's co-insurance or co-payment under the group plan would be their responsibility.

Like most things involving the government, it's kind of complicated, but basically: A participating provider has agreed to submit all claims to the Medicare program. A non-participating provider may choose to submit, or not to submit, claims to Medicare on a case-by-case basis. The biggest practical difference to a patient covered by Medicare is that if they go to a participating provider they will probably only be asked to cover the Medicare co-payment at the time of service. If they go to a non-participating provider, they may be asked to make payment in full at the time of service.

Typically Medicare does not have this type of coverage under its policy. You should find out more information about this from your local Medicare provider.

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

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Provider Transaction Access Number (Medicare Providers)

If the provider is out of network or not contracted with the secondary insurance, they do no have to bill the secondary and the patient is responsible for the balance (if any) owing

Part C medicare is less expensive then traditional medicare. However, with medicare part C there is less coverage so you will have limited services with your medical provider.

I was told that if you switch to another service provider, the new provider will pay off your contract for you.

Constellation Health Medicare Advantage is a Medicare Plan Part C provider. It is a private company that works in addition to Medicare Parts A and B. The person still continues to receive Medicare. The Constellation plan kicks in to cover expenses that are not covered by Medicare parts A and B.

It is solely the provider decision to write off medicare coinsurance due to hardship.

Medicare is nationwide. If you're referring to Medicaid, you're covered if the provider is willing to bill Idaho Medicaid.

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