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Joined: 9/8/2012(UTC)
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I have run into a problem that I haven't quite been able to figure out. I have a patient that has both Medicare and Tricare insurance, but is unable to get approval from either for a sleep device, due to us not being a provider with Medicare, and since they won't officially deny it, Tricare denied it due to lack of information from primary insurance.
My office has chosen not to register in network with Medicare, and we have been told we cannot file any sort of Medical claim with them due to this. If we cannot file a claim with them, (even if only to be denied for those patients with dual insurance), to be able to file to the second, what do I do to take care of my patients?
What would you recommend us to do in this situation?
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
Great question. When Medicare is the primary insurance and you are not enrolled as a participating or non-participating DME supplier or provider with Medicare, many offices choose to refer their patient to an office who can accept Medicare, mainly due to the reason you describe below.
Having said that, some practices have reported sporadic success with including a narrative report with the claim to the secondary insurance explaining that they are not a Medicare provider, therefore unable to produce an EOB or denial from the primary claim for the processing of the secondary claim. In some cases the practice has seen the secondary claim processed, in others the secondary claim is still not able to be processed by the secondary.
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