Reminder: Medicare Secondary Payer Denial Change

CMS issued Change Request (CR) 7355 on August 3, 2012, for services processed January 1, 2013, and after. This CR discusses the appropriate billing of claims for conditional payment. One of the requirements listed in this CR is that for those beneficiaries that have a Group Health Plan (GHP) primary to Medicare and either a liability, no-fault, or workers compensation claim, the charges must be submitted to the GHP prior to submission to Medicare for the conditional payment. If the claims do not show the disposition from the GHP, Medicare will deny the charges as Contractual Obligation (CO). This means the beneficiary is not liable for the charges.