Medicare C Update: Billing Claims with Medicare C as Primary Insurance

January 17, 2012

Starting January 17, 2012, when you bill MaineCare for a claim with Medicare C as primary insurance, you will need to follow these guidelines:

  • Do not submit an 837 for a Medicare C primary claim

If you are billing using paper:

  • Attach the Explanation of Benefits (EOB) to your paper claim

  • Write “Medicare” on the top of the EOB and circle the Paid Date on the EOB

  • The Paid Date must be on the EOB, otherwise the claim will be returned to the provider
  • The Paid Date must be date printed on the EOB by the other payer (Hand-written dates or date stamps will not be accepted)

If you are billing using Direct Data Entry (DDE):

  • Select Medicare instead of TPL on the DDE screen

  • If there is a co-payment amount ,enter this amount into the coinsurance field

If the member is eligible for both MaineCare and Medicare (also known as dual elgibles), the claim will be pended for a manual review. If you have any questions regarding submitting claims with Medicare C as the primary insurance, please contact Provider Services at 1-866-690-5585.