Wiki Non Medicare Provider

[amccoy325]

If a provider is not enrolled with Medicare but the patient has a secondary insurance, is there a modifier we can use to bill the secondary to let them know about Medicare denial.

 

[thomas7331]

There is no modifier for this situation. Secondary payers will almost always require a copy of a Medicare remittance showing how much of the charges are the patient's responsibility, otherwise they won't be able to determine the correct payment due from their plan, unless the service is known to be one that Medicare never covers. It can be difficult to try to bypass this requirement, and the secondary payer may not be willing to pay for a service that Medicare would have covered if the patient had seen an enrolled provider.