I’m in the very early stages of learning and study and confused how to prepare secondary claims on the CMS 1500 form in the case of Medicare being a primary payer and Medicaid being secondary. How would I go about filling out the secondary claim for Medicaid? This part has been most confusing for me
Usually your billing system will attach the primary payer’s ERA with the claim to the secondary payer. You would have to learn how the specific system you’re using will do that. Most insurances will receive an electronic claim so you would not have to send a HCFA 1500 form anyway. In terms of Medicare as primary, if they are aware there is a secondary insurance, such as Medicaid, then they would automatically forward the claim for you to the secondary payer and you would not have to worry about that. I hope this helps. Thank you for watching!
Thank you for this video, very helpful. I am learning about primary and secondary insurance and have a question. Hoping to have a baby next year and opted for covering through my employer because it includes some IVF coverage. Now thinking of getting covered under my husband's insurance too as everything prebirth/birth related is 100% covered by them, whereas with my insurance we would still have to pay for 20% of the cost after deducible is met (80/20 rule). Am I right in thinking that if I get a secondary insurance through my husband's employer, they would pick up that remaining 20% of cost which would otherwise be my responsibility to cover? Thank you!
Hi there and thanks for watching! How exciting. Yes, that is most likely what they would do/how it should work. I encourage you to call his insurance and ask about their secondary coverage with your benefits as primary specifically. That way you’ll know for sure. Good luck!!
Fabulous overview! I've learned a lot about secondary billing over the past year especially, but the inconsistencies are wild. Thankfully all of our secondary monies come via EFT and not checks. I have had to explain to patients why I can't bill a secondary when the clinician only has a contract with the primary and not the secondary. That doesn't mean they can't self-submit if they wanted, to, though, just in case they had OON benefits, right? But I'm not obligated to courtesy submit (everything is manual- we are private insurance only, so no Medicare/Medicaid and no COB) to a secondary when the clinician has no contract, correct? Thanks for being such a great resource!
You are not obligated to bill any insurance. It is always a courtesy for submitting on behalf of patients. You just want your Financial Policy Agreement to reflect the company’s services in this regard and communicate what patients’ roles will be with all of these situations.
Your video was very helpful. Can you tell me if a patient has commercial insurance as primary and Medicaid as secondary. Do the patient still have to pay their co-pay if Medicaid doesn't cover it? Secondary (Medicaid) comes back as "CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT."
Hi there and thank you for watching! Unfortunately when you accept assignment with Medicaid you agree to not bill patients so you would not collect the copay in this situation. I hope this helps.
I have a weird situation. I have great insurance that covers me, my wife and my daughter. Only that it doesn't cover dental. So my wife can opt for insurance from her job, but it's all inclusive. She can't seperate the dental from the medical, and services are offered under one main location. My question is , if we still want to see are same doctors, that don't take my wifes new primary insurance, will the secondary still cover? We don't want to lose our doctors because of this.
Thank you for watching! This is tricky. Medical insurance often does not cover dental and it does have to be purchase separately. I am honestly shocked your wife needs to have it included as it is paid for separately. Did she check with her HR department to see if she can just pay for dental and not medical? That is often okay. If not, it depends if her primary insurance has out of network benefits and it’s not an HMO type situation. If you could keep covering the medical on your work’s insurance and she could just get dental for everyone, that would be ideal. If not, then the secondary coverage situation is tricky and may not be worth it. Please email me at jennifer@icsolns.net if you need other assistance. I’m not 100% sure I can help, but I’m happy to try if you can provide more specifics in the email. Thanks!
I’m in the very early stages of learning and study and confused how to prepare secondary claims on the CMS 1500 form in the case of Medicare being a primary payer and Medicaid being secondary. How would I go about filling out the secondary claim for Medicaid? This part has been most confusing for me
Usually your billing system will attach the primary payer’s ERA with the claim to the secondary payer. You would have to learn how the specific system you’re using will do that. Most insurances will receive an electronic claim so you would not have to send a HCFA 1500 form anyway. In terms of Medicare as primary, if they are aware there is a secondary insurance, such as Medicaid, then they would automatically forward the claim for you to the secondary payer and you would not have to worry about that. I hope this helps. Thank you for watching!
Thank you for this video, very helpful. I am learning about primary and secondary insurance and have a question. Hoping to have a baby next year and opted for covering through my employer because it includes some IVF coverage. Now thinking of getting covered under my husband's insurance too as everything prebirth/birth related is 100% covered by them, whereas with my insurance we would still have to pay for 20% of the cost after deducible is met (80/20 rule). Am I right in thinking that if I get a secondary insurance through my husband's employer, they would pick up that remaining 20% of cost which would otherwise be my responsibility to cover? Thank you!
Hi there and thanks for watching! How exciting. Yes, that is most likely what they would do/how it should work. I encourage you to call his insurance and ask about their secondary coverage with your benefits as primary specifically. That way you’ll know for sure. Good luck!!
Fabulous overview! I've learned a lot about secondary billing over the past year especially, but the inconsistencies are wild. Thankfully all of our secondary monies come via EFT and not checks. I have had to explain to patients why I can't bill a secondary when the clinician only has a contract with the primary and not the secondary. That doesn't mean they can't self-submit if they wanted, to, though, just in case they had OON benefits, right? But I'm not obligated to courtesy submit (everything is manual- we are private insurance only, so no Medicare/Medicaid and no COB) to a secondary when the clinician has no contract, correct? Thanks for being such a great resource!
You are not obligated to bill any insurance. It is always a courtesy for submitting on behalf of patients. You just want your Financial Policy Agreement to reflect the company’s services in this regard and communicate what patients’ roles will be with all of these situations.
Your video was very helpful. Can you tell me if a patient has commercial insurance as primary and Medicaid as secondary. Do the patient still have to pay their co-pay if Medicaid doesn't cover it? Secondary (Medicaid) comes back as "CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT."
Hi there and thank you for watching! Unfortunately when you accept assignment with Medicaid you agree to not bill patients so you would not collect the copay in this situation. I hope this helps.
I have a weird situation. I have great insurance that covers me, my wife and my daughter. Only that it doesn't cover dental. So my wife can opt for insurance from her job, but it's all inclusive. She can't seperate the dental from the medical, and services are offered under one main location. My question is , if we still want to see are same doctors, that don't take my wifes new primary insurance, will the secondary still cover? We don't want to lose our doctors because of this.
Thank you for watching! This is tricky. Medical insurance often does not cover dental and it does have to be purchase separately. I am honestly shocked your wife needs to have it included as it is paid for separately. Did she check with her HR department to see if she can just pay for dental and not medical? That is often okay. If not, it depends if her primary insurance has out of network benefits and it’s not an HMO type situation. If you could keep covering the medical on your work’s insurance and she could just get dental for everyone, that would be ideal. If not, then the secondary coverage situation is tricky and may not be worth it. Please email me at jennifer@icsolns.net if you need other assistance. I’m not 100% sure I can help, but I’m happy to try if you can provide more specifics in the email. Thanks!
@@navigatingthebusinessofmed8251 Thank you for taking the time to reply. I will surely do some more digging.