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November 25, 2013

Submitting Claims for Flu and Pneumonia Vaccines When Medicare is the Secondary Payer

It is important to know if Medicare pays primary or secondary before you submit claims to Medicare. If Medicare is the secondary payer and the patient's group health plan covers pneumococcal and/or influenza virus vaccine and their administration, and all other MSP requirements for the Medicare patient are met, submit the claim to the primary payer first. After you hear from the primary payer, when you file your claim for Medicare secondary payment, please include a copy of the group health plan's explanation of benefits (EOB) (if you are filing paper claims) to ensure the Medicare secondary payment is calculated correctly. For electronic claims, include this information in the appropriate fields.

If you need help determining the primary/secondary status of your Medicare patients, please access myCGS, our free web portal. You can also obtain this information through the Interactive Voice Response (IVR) system.

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