What should I do if I receive two primary payments?

Answer:
There are times when a provider will receive a primary payment from another insurance company after Medicare has paid as primary. When this happens, it is assumed that Medicare should be the secondary payer. If you receive two primary payments, you should refund Medicare’s payment in full.

  • Refund the Medicare payment to Palmetto GBA within 60 days of the date you identify the overpayment, even if Medicare’s records show that Medicare is primary
    • Send a copy of the other insurer’s Explanation of Benefits (EOB) and the Overpayment Refund Form with your check. The Overpayment Refund Form is available on our website under Browse By Topic, Overpayments and Recoupment.
    • If you send a refund without the primary insurer’s EOB, Palmetto GBA may apply the refund to any other accounts receivable for that provider or provider group
    • After Palmetto GBA processes and applies your refund, you may resubmit the claim as a Medicare Secondary Payer claim
    • After 30 days, you may call the provider contact center (PCC) to verify the refunded status. Note: The Interactive Voice Response (IVR) System will not specify that the claim was refunded. The status will reflect processed and paid.
  • Although we will deposit your check almost immediately, it may take as long as 30 days for the status of the claim to show a refund status. Please do not resubmit your claim before we have applied the refund to the original claim, otherwise the new claim will deny as a duplicate.
  • Remember, you can obtain claim status information through the IVR at any time
  • If Medicare records show that Medicare is primary for the patient, Palmetto GBA will request that these records (Common Working File (CWF) records) be updated to reflect that Medicare is secondary. The Coordination of Benefits (COB) contractor will update the records.
    • Please note that updates to CWF records can take up to 100 days
    • To avoid additional overpayments while Medicare’s records are being updated, file all subsequent claims for that patient with the payment information (EOB) from the primary insurer
  • A good resource for understanding when Medicare pays primary or secondary is available on the Palmetto GBA website refer to the MSP Lookup Tool 

Reference: CMS IOM Publication 100-05, Chapter 3, Section 10.4 (PDF, 251 KB)

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