About 85% of Funds beneficiaries are covered through both Medicare and the Funds. For these beneficiaries, Medicare is the primary payer for Part A Services, and the Funds is the primary payer for Part B Services.
All claims for Medicare Part B services provided to Medicare-eligible beneficiaries must be submitted to the Funds for payment. When the Funds is the primary payer, the payment contains the Medicare Part B portion, and the Medicare Part B coinsurance and deductible in one check. If the beneficiary has other coverage that is primary to the Funds, the claim must be billed to the other carrier first. After the other carrier has paid, attach the Remittance Advice and send the claim to the Funds for payment.
Providers should submit Medicare Part A charges to their Medicare intermediary before billing the Funds. After Medicare pays, the provider may bill the Funds for the Medicare Part A deductible, coinsurance, and inpatient hospital extension days. Providers should attach the Medicare documentation (Explanation of Benefits) showing the status of the Medicare benefit, including any Medicare payments, when billing the Funds for these charges.
The Funds is typically the primary payer for Funds beneficiaries who are not eligible for Medicare. Claims for these beneficiaries should be submitted to the Funds for payment. If a beneficiary has other primary insurance, submit claims to their primary carrier first before billing the Funds.