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Filing Claims
The provider submits the claim to Medicare as the primary payer.
However, for the holders of Medigap and other supplemental insurance
policies, quick processing of the supplemental insurance claim is key
to the efficient closing, by service date, of each case, consisting of
medical provider invoice, MSN and EOB (Explanation of Benefits action
taken by supplemental insurance company). And for that reason, I think
it important to discuss (out of order, perhaps) on this "Health
Insurance Paperwork" segment of the Medicare Page, the importance
of selecting a Medigap carrier which has a crossover agreement with
Medicare -- and will again address this subject (in it's proper order)
on the Medigap Web Page -- it is that important.
Based on New
York State experience, I will list in declining order of efficiency the
methods of filing claims. The most efficient method of filing Medigap
and other supplemental insurance claims is "crossover," which
refers to the process of sending Medicare claim information by Medicare
to secondary insurance companies, to facilitate the payment of benefits
under the respective policies. Medicare has trading partner agreements
with certain supplemental insurance companies, which provide for the
electronic transfer by Medicare of claim information to them. If your supplemental insurance
carrier is such a crossover trading partner, but Medicare has not been
informed by them that you are one of their policyholders, your claims
will not be forwarded to your carrier; and there will not be a note on
your MSN that "This information is being sent to your private
insurer." Please contact your supplemental insurer about this
problem, and be sure the insurer has your correct Medicare number. In
effect, the Medicare contactors (insurance companies) who process Part
A and Part B claims for Medicare are filing supplemental insurance
claims on behalf of the beneficiaries, eliminating the need for
beneficiaries, individual providers or medical facilities to file such
claims.
In the
absence of crossover, the other methods of submission of claims are by
the beneficiary or medical provider. I usually suggest that the client
request the medical provider to submit the claims (if the insurance
company permits it). If it doesn't work out with a particular provider,
the beneficiary will have to begin submitting the claims.
Updated:
September 28, 2004
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