Medicare, Secondary Insurance and Coordination of Benefits

March 1st, 2012

Medicare, Secondary Insurance and Coordination of Benefit problems may not be at the very top of our list of reimbursements issue, but it's very close.

  • We see it when Medicare denies because it's not the primary payor,
  • We see it when we get a denial from a secondary insurance company that the patient doesn't have, and
  • We see it when, despite our providing all information via the new nightmarish 5010 standards, Medicare doesn't appropriately "crossover" to secondaries requiring arduous paper filing with Medicare eobs or online submission through the carrier with scanned attachments. 

 No wonder so many offices just give up on secondary dollars!

Medicare relies on the secondary insurance company to self report a new enrollee.  If the secondary company does not, what can a provider do?

The brief answer is, provide proof of the patient's secondary insurance to the COBC (Coordination of Benefits Contractor).

Telephone:  1-800-999-1118 (8 AM to 8 PM Eastern Time)

Fax:  1-734-957-9598 (address the fax to Medicare Coordination of Benefits)

Mailing address:  Medicare –Coordination of Benefits, P.O. Box 33847, Detroit, MI 48232

Because of the number of conflicts in the information CMC and COBC receives, CMS revised its data management "reporting hierarchy" process on December 7.  The official document may be found at:  http://www.cms.gov/MandatoryInsRep/Downloads/GHpHierarchy.pdf

Here are the highlights:

ONE TIME ONLY, a provider office may call the COBC when the patient is in the office and correct the information over the phone.  After that, all proof must be sent by mail or fax.

To speed up your reimbursement process, train your front desk staff to always check secondary insurance.  If there has been a change, be sure to retain proof of the secondary insurance such as an enlarged, legible copy of the secondary insurance card.

If you have an historical problem with a patient's secondary insurance, call the COBC while the patient is in the office and near the phone to attempt the ONE TIME ONLY option to correct over the phone.

Tags: Secondary Insurance, Coordination of Benefits

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