MEDICARE AND SECONDARY INSURANCE

[mass2020]

I am so grateful to have found this forum.  I was using a medical biller who was wonderful but she had a sudden family emergency which left her unable to work and unfortunately I did not keep myself in the loop on the logistics involved in the billing she was doing for me.  I was hoping that someone would be able to help.  I ONLY see medicare patients at an assisted living facility on a very part time basis; I am a psychiatric nurse practitioner in NY.  I am all set up with both Connex (medicare's billing site) and office ally and feel confident in my coding and all the information on the CMS form but where I get hung up is with the secondary insurance.  Does Medicare already have the patients secondary insurance on file and will they just automatically send the claim to them once they process it or is there another step I'm not aware of.  I've heard all different answers from Yes to No you need to submit an entirely different claim to the secondary payer.  I see that on Office ally there is a spot to include the secondary payers info on the original claim but section to fill out an entirely new secondary claim.  If medicare is going to forward this regardless, I find the connex billing portal to actually seem more user friendly.  If anyone can give me any insight on this I can't tell you how much Id appreciate it!  Thanks so much.

[Kerry]

I agree. This is a great forum.  So helpful for all of us billing folks.  You can check the noridian portal to see if they show secondary information.  Typically they do.  But not all secondary insurance information after Medicare is crossed over.  The Medicare RA will show this information when you receive it.  If patient has secondary, but it is not reflected on the Medicare RA, then you would then need to submit to secondary.  I believe, but I could be wrong, the beneficiary is the one who has to inform Medicare to cross over.  And Medicare may not cross over for all secondary insurance companies.