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NOT A MEDICARE PROVIDER

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  • Kathleen Burke

    If you are not a Medicare provider, you will need to create a Superbill and give it to the client. The client will then have to submit the Superbill directly to Medicare. Once the claim is rejected by Medicare, you will need to get a copy of the rejection from the client. You will then need to mail a paper copy of the CMS-1500, along with proof the the claim was rejected by Medicare, to BCBS. Not kidding.

    If you try to submit to BCBS directly without going through Medicare, BCBS will know that the client is over 65, so Medicare should be primary, and reject your claim.

    This is why I will not take any Medicare clients, even if they have a secondary insurance that I accept. I've only had to do this twice, and it was because they were long-term clients who reached retirement age while they were still in treatment. Once retired, Medicare became primary and the nightmare began.

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