Medicare Secondary Claims FAQs

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What is a Medicare secondary claim?

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

What is the effective date of this change?

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.

What types of providers are able to submit 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.

Which of CareFirst’s trading partners have set up this capability?

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.

How soon should I submit a Medicare secondary claim after receiving the Medicare Explanation of Benefits (EOB)?

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.

Are Medicare secondary claims the only secondary claims that can be sent electronically?

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.

Are there any special requirements for posting payments for Institutional claims?

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

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