Fact Based List:

Guidance for Correct Claims Submission When Secondary Payers Are Involved for Medicare Providers

Submitted by Anonymous on Thu, 04/12/2012 - 12:27


  1. Collect full beneficiary health insurance information upon each office visit, outpatient visit, and hospital admission.
  2. Identify the primary payer prior to submission of a claim, and bill the appropriate responsible payer(s) for related services.
  3. For multiple services, bill each responsible payer(s) separately. Do not combine unrelated services on the same claim to Medicare
  4. Providers, physicians, and other suppliers should always use specific diagnosis codes related to the accident or injury. Doing so will promote accurate and timely payments.
  5. Providers should report directly to the COBC any changes to beneficiary, family member’s employment/accident/illness/injury, Federal program coverage changes, or any other insurance coverage info.


Source: Medicare Learning Network Matters Number: SE1217
Source URL: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-...



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