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Primary or Secondary when 2 insurances

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dfranklin:
when a patient presents you with 2 different insurance cards ie Medicare and Anthem BCBS how do you know which is primary and which is secondary?  I have seen it where typically Medicare is primary, but i have also seen it where Medicare has denied and said there is another payor that the claims must be sent to. 

Ultraserve:
When you verify the patient's benefits and eligibility information, you can try to talk a representative and ask if Anthem BCBS is primary or not. Also verifying with Medicare, the CWF will indicate if patient has another insurance coverage that is primary over medicare. If both suggestions dont work. Ask the patient. Also find out if ANTHEM BCBS is an HMO PLAN, if it is then medicare is secondary and Anthem is primary.

Hope this helps and not confuse you more.

dfranklin:
Not confusing...thanks for the reply.  I was hoping to avoid having to call everytime. I use an integrated onilne eligibility within our PM software but we have to know the positions first before running it.  But I guess we will have to call on these ones first. Thanks!

Michele:
Another way to sometimes tell without calling is:

Who is the anthem insurance thru?  The patient or the spouse?  Can you tell if that person is working or retired?  (Sometimes it is indicated on the intake sheet or demographics form)  If the Anthem is thru someone who is currently working it is most likely prime (although not always, if there is less than a certain number of employees, Medicare may still be prime) but if the person is retired, Medicare is prime.

You can't always be sure this way, but it tends to push you in the right direction.  Of course, calling is the only way to be 100% sure, but as a billing service we can't possible call on every patient.  We rely on the provider's office to indicate prime or secondary.  They are not always right, but in most cases they are.

Michele

Pay_My_Claims:
You can't always depend on the insurance company, because they don't always know about the other payor. You should be doing a COB on the client especially when Medicare is involved. If you KNOW that the COB is incorrect and you bill simply because Medicare says its primary and the insurance says they are secondary, but by the COB rules the insurance is primary, you MUST bill correctly.

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