Friday, June 13, 2008

Medicare denial for secondary insurers

Medicare may allow payment for services or items when those services or items are a covered benefit and provided by a person or entity enrolled with Medicare. For a general description of services payable by Medicare, please access the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Pub. 100-04, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 1, Section 10.3.

Providers should submit a claim for non-billable services directly to the patient's other insurance plan, not to Medicare. If the other insurance plan requires documentation of non-coverage, providers can access the references in this article and use a copy of this document with their claim.
Providers of services may not be able to enroll with Medicare as defined in CMS IOM Pub. 100-08, Program Integrity Manual, Chapter 10, Section 6.2.1 and CMS IOM Pub. 100-04, Claims Processing, Chapter 12, Section 10.8. Those providers unable to enroll in Medicare based on their specialty and credentialing are also not able to submit claims to Medicare.

You can access the manual citations listed above at the following Web address:

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