Aetna processing as if secondary to Medicare

Tina B 4 years ago in Payments/ERA Modules updated 4 years ago 2

Wondering if anyone has ever come up against this.  Client has Part A Medicare, no Part B.  Client was in IOP and Aetna has processed claims as if Medicare is primary and adjusting off most of the charge. Aetna is telling us this is a penalty since the client declined Part B Medicare. I don't see how they can do this. They are penalizing us, not the member.


have you added the GY modifier?

When I bill Aetna--No? Client does not have Medicare Part B. I have tried sending the claims to Medicare to see if it would deny and then I could submit to Aetna. They rejected as the member id is not found.