Medicare + Med Supp = Billing Question ?

[sshafran]

It's a snowy day in Phoenix when I get a billing question from a client with a Plan F Med Supp. Just trying to solve it without having to "try" 10 different things.

Here are the details I have so far:
- Client's A&B + Plan F started 4/1/18
- Service date: 4/x/18

The bill states
Primary Insurance: CGS Administrators LLC (immediately, I thought this was the issue - the provider did not bill Medicare. They billed CGS whatever that is. Then looking CGS up online - it looks like they may be some sort of billing contractor with Medicare? Anyone ever heard of them? Is this "Medicare")
Client's name
Client's MCID
Secondary Insurance: None on file

Charge: $210
Medicare OH Payment: $0
Contractual Adjust: -$132
Invoice Balance: $78
Per your insurance this charge was applied to your annual deductible.
(this makes me think that, yes, the bill did get to Medicare, because the claim amount was adjusted and "applied to the deductible.").

So, I called the med supp carrier, and they said that they did not receive the bill. Shouldn't it automatically get there via crossover?

What should my next step be?
- Should the client call the provider and ask them to re-bill Medicare?
- Or should the client call the provider and give them his Med Supp info?
- Or, something else?

 

[TwoCents]

Yes, it should have reached the carrier via the crossover. Why didn't you ask them what to do when you talked to them? I don't see how it would do any good to resend through Medicare. They would likely deny it as already being paid on their end.

 

[goillini52]

It's a snowy day in Phoenix when I get a billing question from a client with a Plan F Med Supp. Just trying to solve it without having to "try" 10 different things.

Here are the details I have so far:
- Client's A&B + Plan F started 4/1/18
- Service date: 4/x/18

The bill states
Primary Insurance: CGS Administrators LLC (immediately, I thought this was the issue - the provider did not bill Medicare. They billed CGS whatever that is. Then looking CGS up online - it looks like they may be some sort of billing contractor with Medicare? Anyone ever heard of them? Is this "Medicare")
Client's name
Client's MCID
Secondary Insurance: None on file

Charge: $210
Medicare OH Payment: $0
Contractual Adjust: -$132
Invoice Balance: $78
Per your insurance this charge was applied to your annual deductible.
(this makes me think that, yes, the bill did get to Medicare, because the claim amount was adjusted and "applied to the deductible.").

So, I called the med supp carrier, and they said that they did not receive the bill. Shouldn't it automatically get there via crossover?

What should my next step be?
- Should the client call the provider and ask them to re-bill Medicare?
- Or should the client call the provider and give them his Med Supp info?
- Or, something else?

I'd get a copy of the EOB from Medicare and file it manually with the Med Supp company.

 

[goillini52]

Yes, it should have reached the carrier via the crossover. Why didn't you ask them what to do when you talked to them? I don't see how it would do any good to resend through Medicare. They would likely deny it as already being paid on their end.

Looks like there's nothing being paid on Medicare's end, as the $78 balance is applied to the Part B Deductible. Looks like the crossover didn't work on this one.

 

[DS4]

I'd get a copy of the EOB from Medicare and file it manually with the Med Supp company.

Yep.

 

[LostDollar]

CGS Medicare

There's a little bit about the cgs organization. I thought somewhere there are maps of those contractor regions but I can't put my hand on them.

I had a billing issue for one claim and a Medicare representative told that (because of circumstances surrounding the claim) Medicare would not send the bill to my Medigap plan and he put in a request for an MSN for me so I could send it on to the Medigap carrier when I got it. There may be some kind of similar conflict in your situation and you will just have to see a copy of the MSN gets to the Medigap carrier. If your client has lost the one they got, they can create a mymedicare account and request another.

 

[somarco]

Some carriers do not participate in crossover.

 

[sshafran]

Why didn't you ask them what to do when you talked to them?

Mainly because the carrier rep that I spoke to was... how should I put it... Not very helpful. She told me that "all she could tell me" was that they did not get the bill to pay the claim. She could not "guide me on how to fix it" as it's a "third party issue." So, I asked, but she didn't answer.

CGS Medicare

There's a little bit about the cgs organization. I thought somewhere there are maps of those contractor regions but I can't put my hand on them.

I had a billing issue for one claim and a Medicare representative told that (because of circumstances surrounding the claim) Medicare would not send the bill to my Medigap plan and he put in a request for an MSN for me so I could send it on to the Medigap carrier when I got it. There may be some kind of similar conflict in your situation and you will just have to see a copy of the MSN gets to the Medigap carrier. If your client has lost the one they got, they can create a mymedicare account and request another.

Thanks - sometimes it's helpful getting the consumer/end-user perspective.

Some carriers do not participate in crossover.

It's UHC - so no problem there.

 

[sshafran]

I'd get a copy of the EOB from Medicare and file it manually with the Med Supp company.

That sounds like the consensus. Thanks.

 

[sshafran]

While waiting for replies and trying to figure out things, I called UHC again.

She told me that the first claim normally needs to be done manually - i.e., crossover "doesn't work" on initial claim when provider just bills Medicare - provider needs to bill both.

This was news to me (and doesn't sound 100% accurate). And because the provider just billed Medicare, and didn't bill UHC, she said that the crossover was not "triggered."