Wiki Jeanie Bilodeau, CPC


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I need some help on billing patients involved in MVA's. Does anyone have some input on who should be billed when a patient is involved in an MVA? Is the responsible party the patient, do you bill the patient or the patient health insurance?:rolleyes:
Billing Auto Claims

Auto is always Primary over fereral health plans like Medicare and Medicaid along with Tricare, and don't forget federal bcbs. In the state of Michigan, a No-fault state, it depends on how the health insurance policy is written. One common carrier, Cofinity, have conracts that will exclude auto claims, and some of the bcbs contracts exclude auto claims. More and more contracts are rejecting claims when auto is indicated on the claim. Some health carriers will do an automatic take-back after paying claims after they get wind of an auto claim. We always request letter from auto stating if they are primary and if it is an open claim (because they never give true authorization in Michigan)
And check the health care benefits to see if auto claims are excluding for coverage.
If a patient does not have personal injuy coverage on their auto insurance, who do you bill? Do you go ahead and bill the medical insurance?
What state are you in? I would poke around your state's website and see if they have a Motor Vehicle Fee Schedule or something similar. Here in NJ we have a PIP fee schedule and all auto insurers are required to provide PIP coverage. Other states will use their Worker's Comp fee schedule. It really depends on where you are. If they have no PIP coverage, then you may need to get an Affidavit of No Insurance showing that they aren't covered by the auto before health insurance will pay anything. And I would disagree with orthobiller2000, that the auto primary isn't universal. In NJ we have an option called Health Insurance Primary, where the claimant's normal health insurance pays first, then the auto, and this option is selected by the claimant when they purchase their policy. Otherwise, hope I could help! :)