PMAP secondary to Medicare

Ashley Kallod 7 years ago in Billing/Electronic Modules updated by Mark Cornell 6 years ago 5

Hello -

As it is so difficult to get someone on the phon at Medicare, I thought I would post here to see if anyone else has experienced this issue.  We have had issues with billing for substance use disorder services in the last few months with PMAP policies that are secondary to Medicare.  What most recently happended is that the client didn't inform us of a primary Medicare policy, and we found out about it after getting claim denials from the secondary BCBS MN PMAP policy.

Here is the issue:  our facility and providers are not Medicare eligible - in fact in the past Medicare has told us that we cannot send claims to them; Medicare stated that patients would need pay us directly for services, and then send claims to Medicare themselves in order to get reimursed.

I'm at a loss at this point as to how to proceed with secondary claims to BCBS MN - I can't get a denial as I can't send claims, and BCBS MN won't pay without COB information.  

Any advice?!


Hello Ashley,

I hope I can help you.  I don't have the outgoing letter that triggered this letter from Medicare, but we received a letter from Medicare as follows:

Dear Ms X,

I am writing in response to your May 16, 2013, letter, received in our office on May 21, 2013, requesting a response from Medicare regarding your ineligibility to enroll in the Medicare program.

Licensed professional counselors and licensed alcohol and drug counselors are not eligible to enroll as practitioners in the Medicare program and the services they perform are not eligible for Medicare coverage.

If your patients have other insurance benefits available, claims for your services should be submitted directly to that insurance plan.  If the other insurance plan requires documentation that your services are not eligible for Medicare reimbursement, you may use a copy of this letter to provide that documentation.

...and so on.

Our secondary insurances are typically PrimeWest, but should be the same principle.  I sincerely hope this helps you to get paid.


Sheryl - this is extremely helpful!  I'm going to look into contacting Medicare to see if I can get a similar letter.  I so appreciate this!

No problem, Ashley.  I had to learn and am happy to help someone else get there.  Best to you!


Ashley, were you able to receive the necessary letter from Medicare.  I am having a similar issue with Medicare for psychotherapy sessions.  I was curious to see how you obtained the letter.

Thank you,

We have had this letter on file with BCBS  and they still deny claims, we have even tried the GY modifier.

Any other suggestions?