Medicare Supplement Insurance Claim process

[NewBeeCA]

Hello Everyone,

I have been selling Medicare plans for a couple of years in California. I have sold both Supplement and
Advantage plans, mainly from the major carriers.

I notice that there are very competitive Medicare Supplement plans available from carriers one would not
normally associate with Health insurance - Allstate, Mutual of Omaha, etc. They are a very attractive option
because the benefits are all standardized by Medicare and they are economical. However, I am not sure about
how familiar doctor's/ offices/providers with these companies are as as far as claims paperwork.

For the plans I have sold so far, from companies like United Healthcare, Blue Shield, etc., the claims are forwarded
by Medicare automatically to the carriers after Medicare processes them.

Does Medicare forward claims to the carriers regardless of the carrier after processing it as a standard practice?
Do the clients of these companies have to do anything extra (like manual submission) of claims to the carriers?

Thanks in advance for all the answers.

NewBeeCA

 

[Panda1]

Medicare does forward the claim to the supplement company. My wife and I have sold many different companies supplements over the years and have had very few issues outside of something not coded properly. I've seen several companies come and go and haven't had but a few issues.

 

[NewBeeCA]

Medicare does forward the claim to the supplement company. My wife and I have sold many different companies supplements over the years and have had very few issues outside of something not coded properly. I've seen several companies come and go and haven't had but a few issues.

Thank you Panda1!

 

[Panda1]

By the way. When customers gets his EOB it says claim will be forwarded to the insurance company.

 

[somarco]

EOB comes from the carrier after the claim is paid.

Beneficiaries receive the MSN from Medicare but that is usually long after the claim has been paid by Medicare and the Medigap plan.

Also, there is virtually no paperwork with regard to Medicare/Medigap. Claims are filed electronically with Medicare who adjudicates the claim then sends it to the Medigap carrier (in most situations) via crossover.

Very few OM claims require prior authorization which is usually handled electronically as well.

Providers are very much aware of how claims are handled. However their office staff is often clueless about the difference in OM vs managed care.

 

[Panda1]

I stand corrected it is MSN. The EOB comes from company

 

[LostDollar]

EOB comes from the carrier after the claim is paid.

Beneficiaries receive the MSN from Medicare but that is usually long after the claim has been paid by Medicare and the Medigap plan.

Also, there is virtually no paperwork with regard to Medicare/Medigap. Claims are filed electronically with Medicare who adjudicates the claim then sends it to the Medigap carrier (in most situations) via crossover.

Very few OM claims require prior authorization which is usually handled electronically as well.

Providers are very much aware of how claims are handled. However their office staff is often clueless about the difference in OM vs managed care.

I stand corrected it is MSN. The EOB comes from company

Caveat, not an agent.

I have been told here the term used to be MEOB. My medigap carrier still uses that term so I need to be careful to use it with them for clear communication when discussing claims.

 

[Panda1]

Yes I think I do recall that term. Seems after all these years "EOB" has become kind of a generic term since they both convey essentially the same information. Oh well anyway!

 

[LostDollar]

Medicare does forward the claim to the supplement company.

Also, there is virtually no paperwork with regard to Medicare/Medigap. Claims are filed electronically with Medicare who adjudicates the claim then sends it to the Medigap carrier (in most situations) via crossover.

(I use MEOB below because that is what my Medigap carrier uses.)

Caveat, not an agent.

On my claims, claims from Part B hospital providers have been treated differently from other Part B claims.

For my non-hospital Part B providers, the Medicare claim -- if and when approved -- is forwarded to the Medigap carrier.

For Hospital Part B claims, there are two differences on the MEOB.

1) If the service is approved by Medicare then the Medicare Approved Amount in column 3 of the MSN/MEOB is shown as 100% of the Hospital Part B provider's charge.

2) For the Hospital Part B provider, the claim is NOT automatically forwarded to Medigap. You can see this clearly from my MEOB's, all the non-hospital provider claims have the crossover footnote, the Hospitals do not.

This is not a one hospital or one year claim abberation. I have had that happen with one hospital's claims in two separate years. I have also had that happen with two different hospital's claims in the same year.

There appears to be some distinction in the claims process for Part B hospital providers,

 

[goillini52]

Pretty Girls in your city

Is that a statement, or a question?