cmarcumcpc
Guest
We are currently doing an audit of claims from 2010 & older. We have lots of credits and we're trying to figure out if they are patient vs insurance. One of the things I'm finding is:
Patient has Primary & Secondary coverage for example, Anthem Primary & Medicare Secondary. The Anthem will process the pymt w/allowable amt & an adj, leaving balance to patient. Then Medicare comes in and process the claim as primary, their allowable is higher or even sometimes lower than the primary commercial insur. This creates a credit on the acct. Sometimes the CARC code is 23 - impact of primary payer.
I'm being told by Medicare that if their allowable amt is different from the primary when they are secondary and they apply the CARC code 23 it allows Medicare to come in and pay as primary.
My superior says this is not how it's supposed to work. I've tried finding an interpretation of CARC code 23 that speaks in plain English but it's next to impossible. Does anyone understand this process of billing?
Patient has Primary & Secondary coverage for example, Anthem Primary & Medicare Secondary. The Anthem will process the pymt w/allowable amt & an adj, leaving balance to patient. Then Medicare comes in and process the claim as primary, their allowable is higher or even sometimes lower than the primary commercial insur. This creates a credit on the acct. Sometimes the CARC code is 23 - impact of primary payer.
I'm being told by Medicare that if their allowable amt is different from the primary when they are secondary and they apply the CARC code 23 it allows Medicare to come in and pay as primary.
My superior says this is not how it's supposed to work. I've tried finding an interpretation of CARC code 23 that speaks in plain English but it's next to impossible. Does anyone understand this process of billing?