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Thread Topic: Medicare EDI claims
Topic Originator: Lucy Peterson
Post Date October 10, 2012 @ 4:39 AM
Medicare EDI claims

Lucy Peterson
October 10, 2012 @ 4:39 AM Reply  |  Email Friend   |  |Print  |  Top

Hi all,

Many of my Medicare claims recently denied bcs 'Did not indicate whether we are primary or secondary payer'.

Medicare should know that they are primary carrier for the patient. I submitted the claims by EDI and Medicare was entered there as primary insurance.

Any advice please?

October 26, 2012 @ 5:49 PM Reply  |  Email Friend   |  |Print  |  Top

I would call your local Medicare office and speak to someone in the claims department. Even though the patient and you both know that the Medicare policy is primary and you have labeled it as such in the patient's medical records, there could be an old automobile accident open/on file or a work comp case that has yet to be closed out. Sometimes Medicare mails patients literature to confirm coordination of benefits and because the patient doesn't understand what Medicare is asking, they ignore it, and the claim gets denied. Start with Medicare claims department and if that doesn't pan out for you, have the patient call Medicare themselves and see if they can't get it sorted out.

Lucy Peterson
October 27, 2012 @ 8:50 AM Reply  |  Email Friend   |  |Print  |  Top

Thanks so much, mwayne

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