Medicare Primary- Commerical Insurance

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3
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I have a client who did not tell us that he had Medicare as primary (or at all). We are now getting a denial from the commerical payor asking for an EOB from medicare denying services. In the past I've tried to obtain a denial for medicare and they just don't respond. The carrier I am trying to appeal with is HealthNet.

Any suggestions?
 
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265
Location
Albany
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0
You have to bill Medicare for the service. If Medicare denies for Timely Filing you can appeal with the commercial insurance denial and notes that you did not receive the correct insurance information (Medicare) at the time of service. Once Medicare pays you can send that claim to the secondary. They might deny duplicate and you will have to appeal with the Medicare denial.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
 
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