Medicare Supplement Insurance Claim process

[LostDollar]

The patient can only present the Medicare card and be done with it. The provider is not allowed to submit claims direct to the Medigap carrier .

As I have said before, there appears to be an exception to this for some hospital part b provider billings. I have not been able to learn the reason for this.

One other possible exception to this could occur if the first claim a Part B provider submits for a service is denied and the provider then submits a second claim which is approved. I think I have read or heard that CMS will not crosswalk anything but the first claim for a service.

(I have had one instance where a provider submitted a claim 3 times to CMS before he got it approved but I doubt I still have MEOB's available see how the crosswalking might have worked in that situation.)

 

[rmhaire]

Caveat, not an agent.

I have never been able to make somarco's process of submitting only a Medicare card work.

The billing people at most of my Part B providers understand exactly how the process works, but they do insist that I provide both my Medicare and Medigap cards. I have so many things I can stamp my foot and loose my temper about, this one is not worth the trouble since I have, and always carry, both cards.

(Billing person at a now retired doctor's office once told me she wanted to be able to track the progress of billing and payment.)

1st, @somarco is correct. It's no longer required thanks to modern technology.

When I go to a doctor, I always throw down both cards. Even when my supp card is not requested. I just get a kick out of watching the look on their faces while they're trying to figure out what the hell I just gave them.

Years ago, when my wife stopped driving, I still carried her drivers license on me for id purposes.

Every time I'd go to a doctor and the girl at the window asked for my medicare card and a picture id, I'd give them my wife's license.

When they gave me that puzzled look, I'd take hers back and say "My bad. That one was before my sex change operation"

Goin to the doctor is a bitch. Might as well have fun with it.

 

[LostDollar]

When I go to a doctor, I always throw down both cards. Even when my supp card is not requested. I just get a kick out of watching the look on their faces while they're trying to figure out what the hell I just gave them.

Again, this is an experience I have never had here. I am asked for both cards and the people at the front desk know what I am giving them.

 

[rmhaire]

Again, this is an experience I have never had here. I am asked for both cards and the people at the front desk know what I am giving them.

Could be as simple as exactly what's in your client file at you doctors office.
Who knows?

All I know is how OM used to work and how it works now. They changed it in the 90's.

Your doctor or provider can send a bill to your supplement carrier if he wants to but he's wasting time and paper. They're not even going to read it.

 

[LostDollar]

Could be as simple as exactly what's in your client file at you doctors office.
Who knows?

All I know is how OM used to work and how it works now. They changed it in the 90's.

Your doctor or provider can send a bill to your supplement carrier if he wants to but he's wasting time and paper. They're not even going to read it.

As I have said multiple times, and can't get anybody to believe me, there are some hospital Part B claims, that, at least according to the MSN, are not crosswalked to Medigap, so the provider must send the bill to Medigap.

I also believe I have read that if a provider claim is denied by Medicare on the first submission, a later corrected submission approved by Medicare is also not crosswalked, but I am not sure on that one.

I am basing my "not crosswalked" statement on the fact that the MSN does not have a submitted to Medigap carrier statement on the bottom of the report like non-hospital Part B provider claims do.

This is a factual statement for Part B bills from two different hospital part B providers in Kansas. My Medigap carrier(s) did read those bills.

I have spoken about this before in posts, no-one has ever acknowledged those statements.