Medicare C Claims Update

February 14, 2012

On January 13, 2012, we sent a listserv outlining the process for submitting balances to MaineCare for Medicare C claims. At that time we were not able to give you instructions for claims that had already processed incorrectly. We have evaluated the possibility of reprocessing these claims automatically and have found that it is not possible. Specific information needs to be changed on the claim to derive the correct payment. Please use the following instructions for submitting Medicare C claims for services prior to January 17, 2012. Because timely filing edits are now enforced, please submit any of the corrected claims within sixty (60) days of this notice. These corrected claims will need to be submitted as adjustments. 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 the date on the EOB is only reflected on page one of a multi-page EOB, attach page one along with the page(s) that pertain to the member you are submitting a claim for.

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

  • Select Medicare instead of Third Party Liability (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 pend 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.