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Bill Secondary Payers When You Are Not Medicare Eligible

Overview

Learn how you may be able to send claims to a secondary payer when you are not able to send claims to Medicare because of licensing and credentials.

If you do have licencing and credentials that would allow you to send to Medicare but you haven't gone through the registration process, then the solution outlined below will not be allowed. You must go through Medicare if you can.

Prior to completing these steps, check with the payer to see if your contract allows you to use a GY modifier.  The GY modifier will appear on all claims for this client and will indicate to the payer that you are not Medicare eligible; therefore, you need them to pay the claim as if they were primary and Medicare did not exist.

Update the Client's Record

  1. Go to the Clients Module.
  2. Double-click on the client you want to work with. 
  3. Click the Payers tab.
  4. Inactivate the Medicare payer (if entered).
    1. On the Enrollment sub tab, choose the Medicare payer in the payer drop-down menu (to the right of the Documents sub-tab).
      • ​The screen will refresh. 
    2.  Change Active: to Inactive .
  5. Make the non-Medicare primary.
    • Depending on the order, Procentive may have moved it up to Primary, if not, follow the steps.
      1. Using the payer drop-down again (Step 4.1),  select the non-Medicare payer.
        • ​The screen will refresh. 
      2. Click the Make 1st button to move it to Primary.
      3. In the field Add modifier to all claims: Enter GY .
      4. Click Save.

​​​​You are now ready to submit claims for this client to the non-Medicare payer. 

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