A Group Health Plan (GHP) has recouped a primary payment on a claim processed over a year old indicating Medicare should have been primary. Will Medicare override timely filing rules and process an adjustment claim?

Answer: No. The GHP may request that the provider either submit an initial claim to Medicare or request that Medicare reopen its determination on previously submitted claims for the services; however, normal Medicare timely filing and reopening rules apply to these situations. Please refer to Section 10.5 — Incorrect GHP Primary Payments (PDF, 235 KB).

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