Medicare Secondary Claims FAQs

Answer: A Medicare secondary claim is a claim that did not automatically cross over from Medicare. The automated Medicare cross over process remains unchanged.

Answer: CareFirst implemented changes on July 27, 2012 for professional providers and Nov. 1, 2014 for institutional providers that allow submission of Medicare secondary claims electronically.

Answer: All providers with a clearinghouse that has established this capability with CareFirst can submit Medicare secondary claims electronically. Please contact your clearinghouse to verify.

Answer: All of CareFirst’s clearinghouses (RealMed, Emdeon, Allscripts and RelayHealth) have set-up this capability. However, providers should contact their clearinghouse directly to make sure the capabilities have been set-up correctly for their practice.

Answer: Always allow 30 days from receipt of the Medicare EOB for claims to automatically cross over from Medicare and be processed by CareFirst before submitting a secondary claim to CareFirst.

Answer: Yes, at this time, only the Medicare secondary claims can be sent electronically. Providers should continue to send other secondary claims on paper with a copy of the EOB.

Answer: Yes. Outpatient claims must have payment and adjustment information posted at the line level. Inpatient claims are posted at the claim level.