Hi everyone! I've had a frustrating couple of days trying to get to the bottom of this. We have a Medicare patient with a UHC Dual supplementary plan. In addition, he also has a (Medicaid) QMR plan. I was told by the Medicaid rep that Medicare should have the QMR information on file and after they pay their portion, they automatically route it to QMR for their portion of the claim.
However, according to the ERA, there's no evidence that it was process through QMR, only though UHC, which is the patient's secondary insurance.
This leaves a patient balance that varies from DOS to DOS. Per QMR rules, (from what I've been told by their rep) we are not allowed to bill the patient for any DED or coinsurance amount.
Since there's no way to send the claims directly to them with Medicare's EOBs for them to pay their portion (it can only be submitted through Medicare) what's the protocol for this situation? This isn't our only patient with this issue going when it comes to their billing.
