What happens when a claim is sent to Medicare regarding the secondary payer?

What happens when a claim is sent to Medicare regarding the secondary payer?

• A. Medicare denies the claim
• B. Medicare forwards the claim to the secondary payer
• C. Medicare forwards the claim to the primary payer
• D. Medicare closes the claim without action

Answer: (B)

When a claim involves Medicare as part of a secondary payer arrangement, the process is about coordinating benefits with the other payer that has the primary responsibility. In this setup, Medicare does not determine payment in isolation; instead, it passes the claim on to the other payer (the primary payer) so that that payer can adjudicate first and determine any remaining liability. After the primary payer has processed, Medicare can then review what, if anything, is left to pay as the secondary payer. This coordination ensures the correct order of payment and prevents double payment or gaps. So the correct action is that Medicare forwards the claim to the other payer to coordinate benefits. The alternatives—denying the claim outright, forwarding to the primary payer, or closing the claim without action—do not reflect how Medicare coordinate-of-benefits procedures work in MSP scenarios.

When a claim involves Medicare as part of a secondary payer arrangement, the process is about coordinating benefits with the other payer that has the primary responsibility. In this setup, Medicare does not determine payment in isolation; instead, it passes the claim on to the other payer (the primary payer) so that that payer can adjudicate first and determine any remaining liability. After the primary payer has processed, Medicare can then review what, if anything, is left to pay as the secondary payer. This coordination ensures the correct order of payment and prevents double payment or gaps.

So the correct action is that Medicare forwards the claim to the other payer to coordinate benefits. The alternatives—denying the claim outright, forwarding to the primary payer, or closing the claim without action—do not reflect how Medicare coordinate-of-benefits procedures work in MSP scenarios.