Forum - Questions & Answers

Oct 14th, 2014 - LITA 1 

Medicare forwarding Secondary claims

Our office has recently had several issues with Medicare not forwarding the claim to the patients secondary insurance (the secondary was included on the claim we initially sent to Medicare). When I called Medicare I was told it is the patients responsibility to contact the "COB" department and give them the secondary information so that claims can be forwarded. Several of these patients have been coming here for years and have never changed their secondary plan and we have been paid every year with no issues. Is anyone else experiencing this issue?

Oct 14th, 2014 - youngblood 278 

re: Medicare forwarding Secondary claims

Most of our claims forward, but there are a few that we still have to send on paper. There are occasional auto-crossover failures as well. We tend to run across the COB problem when our patients are newly on Medicare, and they do need to call the national database to verify that Medicare has the correct COB data (you cannot do it for them). Continuing to work and have the employer's coverage primary, or electively not activating part B can also cause problems.

Oct 14th, 2014 - LITA 1 

re: Medicare forwarding Secondary claims

Thanks for the response. I'm used to the usual reasons for not forwarding but this was a first for me and the fact that it happened several times on one remit just seemed odd. Thanks again for your help!!

Oct 14th, 2014 - youngblood 278 

re: Medicare forwarding Secondary claims

All on one remit would point me to the auto-cross failure. Another thing to consider is a detrimental system "upgrade" causing a glitch either at the eligibility source or your EDI clearinghouse.

Oct 14th, 2014 - Hilde 2 

re: Medicare forwarding Secondary claims

Yes, I have had strange intermittent Medicare crossover/COB problems from time to time. As far as I know, the only thing to do is have the patient call COB.

I think sometimes it is just a "glitch" wtih the receiving secondary insurance company. The Medicare EOB clearly shows the crossover, but the secondary ins company says they never got the claim. And then the next DOS crosses over fine. Go figure.....



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