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<br />~ . /~1 /1= lUll fL.A~/VII= <br />~ <br /> <br />jfjIUJLILIl:: II. II~ <br /> <br />" <br /> <br />"!!! <br /> <br />TO: <br /> <br />INTERMEDIARY <br />ADMINIS-TRATIVE BULLETIN NO. 476 <br /> <br />ALL MEDICARE HOSPITAL PROVIDERS <br /> <br />FROM: <br />\ DA TE: <br />SUBJECT: <br />\ <br /> <br />Joy 8ahnemann, Vice President, Governrn.ent Programs <br />October 1990 <br />rtospita~ Manual Transmittal No. 593 - Medicare Secondary Pay.,.. <br /> <br />Please review the enclosed manual transmittal very carefully before ;ncorpor.ting <br />it in to your manual. I t is very important that this bultetin and transmithl b. <br />shared with the appropriate personnel in your facility as it concerns some m.jor <br />changes in the handling of claims involving accident-related services. <br /> <br />Transmittal number 593 <br />New Implementation Instructions <br />Effective for sl!rvice dates furnished on or aftar November 13, 1989. . <br /> <br />~. This transmittal Covers the new regulations involving no-hult insur-ane:. <br />- .~ coverage. The definition of no-fault _has been expanded to include all types of <br />.;~ no-fault insurance. Thus, Medicare is secondary to .11 types of Insul'"ance <br />(including homeowners and commercial plans) th~t pay for medical expanses <br />A, sustained on the property or pl"'erni~as of the insured f'eg~rdrass of who may b. <br />D- . -- responsible for c~using, the ~ccident. This includes p~yments under medical <br />payment coverage (common!y referred to as Med pay coverage) 6 personal injury <br />protection or medical expense coverage. ___ <br /> <br />- <br /> <br />As the result of these new regulations6 the provid~r must first bill the no-f;ult <br />- insurance. Conditional Medicare payment will only be made-under the following <br />circumstances: <br /> <br />o <br /> <br />The beneFiciary hOls filed a claim with the no-Fault fn:sural" 4lnd tha <br />insurance carrier - doe$ not pay w~thin 120 days of receipt of the c:t;ims~ <br /> <br />Th e be.neficiary, bec.u sa of physical or ment;1 incapacity, hiled to m.at a <br />claim 'filing requirament of the no-hult insurer. <br /> <br />A ny claim filed to Medicara i8QUuting conditional payment ~ have a denial <br />from the no-hult insu-l"'.;nc~ or prooF that tho no-hult insuranc. company wiJI nc~ <br />pay the claim within 120 days of receipt of the claim. Claims filed without: an <br />e)(pl..n~tion that a full or padial payment Calnnot be made by the no-hurt <br />insurance cOlrrier will b. denied by Medic4Ire. <br /> <br />o <br /> <br />Wh~n raque:sting conditional p;yment, b. sur. the UB~a2 is completed co,..ractly~ <br />Att~chment 1 is ~n eXimpl. of . UB-S2 conditional piyment requost. <br /> <br />R~fu:s~1 by the patient to file . claim with the no.hult insurance eompany or to <br />coopi!r~t. with the provider filing such a c1.~im is not a bHis - for c1aimins <br />conditional payment. <br /> <br />'-'- (ijJ Slue Cross "" <br />~ ~ ~.~~.~hield <br /> <br />P.O. Sox 64357 <br /> <br />51. Paul, MN 55164 <br /> <br />Fede,aI ..., <br />Interm~ <br /> <br />- <br /> <br />:(fJ <br />