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Primary vs Secondary Insurance

  1. Default Primary vs Secondary Insurance
    Medical Coding Books
    Can someone refresh my memory as to the general rules for determining which carrier is primary when someone is covered under two commercial group/indiv plans? It used to be earliest date of birth of the policyholders, I think....

  2. #2
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    If it is a child the primary ins is the ins of the parent with the first birth month of the year. For example the parent with the Feb birth month insurance would be primary to the parents birth month of July. If the pt has Medicare and a working spouse in order for spouse insurance to be primary there must be over 100 employees, and if both have commercial insurance, whoever the patient is their insurance is primary. I hope this helps.
    CRC CPC

  3. #3
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    Quote Originally Posted by colleenrcox View Post
    If it is a child the primary ins is the ins of the parent with the first birth month of the year. For example the parent with the Feb birth month insurance would be primary to the parents birth month of July. If the pt has Medicare and a working spouse in order for spouse insurance to be primary there must be over 100 employees, and if both have commercial insurance, whoever the patient is their insurance is primary. I hope this helps.
    Isn't it 20 employees?

    10.3 - The 20-or-More Employees Requirement
    (Rev. 1, 10-01-03)

    https://www.cms.gov/manuals/downloads/msp105c02.pdf

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