APPEALS: I received a remittance advice with the message “this care may be covered by another payer per coordination of benefits.” Is this an appealable claim?
No. It is the providers’ responsibility to determine if Medicare is primary or secondary payer. To avoid this denial, check to see if your patient is enrolled in another plan before you submit your claim. Research NGSConnex for eligibility facts. Make sure that you are looking at the validity indicator within NGSConnex, effective date and termination date. If your date of service falls between those dates you should submit your claim to the other insurance first.
When submitting claims to NGS as the secondary payer, submit all required loops and segments by using the Electronic Data Interchange: Medicare Secondary Payer ANSI Specifications for 837P guide.
Reviewed 11/08/20204