Medicare Secondary Payor - What
Is It?
Medicare may not always be the primary source of payment for
health services for Medicare beneficiaries. Congress passed
legislation in 1980 stating that Medicare may not make payment
for services that are covered by certain other insurances or
programs. Medicare may become secondary in the following situations:
Accidental Injuries
- Automobile, Medical or Personal Injury Coverage.
- No fault, Medical Payment (MED PAY) Coverage.
- Liability Insurance.
Worker's Compensation
Employer Group Health Plans (EGHP)
- Working Aged (65 and over).
- End-Stage Renal Disease (Kidney Failure).
- Dual Entitlement.
- Disability (Under 65).
Veteran's Administration (VA)
Black Lung Program
Public Health Services (PHS) and
other Federal Agencies
What is a Conditional Payment?
Medicare may make a payment on a conditional basis if it is
determined the primary insurer will not pay within 120 days
of the receipt of the disputed claim. Liability and worker's
compensation issues allow conditional payment until a settlement
is reached.
What if the Primary Payor won't pay?
Medicare may consider a claim for secondary payment if the
other payor denies the claim or does not pay the claim in full.
If you have questions in regards to MSP, or any other Medicare
questions, you can call toll-free (877) 602-7909. |
