Ask the Contractor Teleconference

September 29, 2005

Topic: Medicare Secondary Payer

Questions & Answers

Question 1: . What should we tell a beneficiary questioning their eligibility?

Answer 1: You can refer beneficiaries to 1-800-MEDICARE.

Question 2: Where can I find additional information regarding MSP?

Answer 2: You can refer to the NHIC Medicare Secondary Payer guide.  Please refer to the NHIC website (www.medicarenhic.com) click on Publications and then Medicare Secondary Payer-MSP (7/2005).

Question 3: Is this a correct statement, When a claim goes to Medicare Secondary Payer on a paper claim, we are not to enter the amount paid in item 29, and send with the primary EOB?

Answer 3: That is a correct statement. Item 29 is used only if the patient pays an amount up front, at the time of the service.  If another insurance made payment before Medicare, that payment amount is not to go in item 29. The explanation of benefits from the primary insurance will provide us with the information about what & how the other insurance paid so we may pay accordingly.

Question 4:    What about electronic billing to Medicare Secondary Payer. Do we enter    amount paid in the field for item29. If we do not enter in an amount how  will you know who the primary payment is from?

Answer 4: Item 29 is used only if the patient pays up front for the service, not if another insurance pays.  Contact your software vendor and the EDI department about correctly supplying Medicare with all the needed  information when billing a secondary claim electronically.

Question 5:   If we send electronic should we be faxing the primary EOB to the EDI department?

Answer 5: For billing a secondary claim electronically, please see our Medicare Secondary Payer billing guide for specific field information.  Completing the required fields for electronic billing would suffice our needs without having to obtain a copy of the primary insurance’s explanation of benefits.

      You may call our EDI department for NE at 781-749-7745, SCA at 213-593-6950 and NCA at 530-896-7024 for assistance with electronic billing.

Question 6: If the primary insurance is BCBS and we submit radiology services to them they require that they be submitted as professional/technical.  The code is entered twice.  Once with the 26 modifier and once with the TC modifier.  If Medicare is secondary for these services and we submit    the claims as billed to BCBS one of the services denies as a duplicate even with the modifiers on the transactions.   Do we need to rekey the services as one transaction to Medicare?

Answer 6: If the 26/TC is billed on the same claim it would be payable. If there   was a global code already paid and the 26/tc is billed on different claims, it could depend on the modifiers being billed.

11/23/05