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Bypassing Primary Payer when Billing Option(s)?

Jeremy Roelofs-Lynch 2 years ago in Billing/Electronic Modules updated by Kim N 2 years ago 3

Does anyone know if it is possible to bypass a primary payer that does not except our codes when the client has a secondary payer that does except them? I.e. Modifier? 

NOTE - primary is NOT Medicare or a Medicare Product. (We use GY)

Setting up a "bogus" auth for the first payer.

Lets say you want the 9 codes to go to primary, but you want H codes to bypass Primary and go to secondary.

Set up Primary to require Auths for that client, then add in "auths" for 9 codes.  The H codes will not be listed in Auth for Primary so Procentive will skip it and Que up the secondary. 

Thank you Kim!


When you do this doesn't the secondary payer deny the claim due to COB????


Thank you again.

It depends on the situation and payer.

For us, some commercial payers don't cover H codes.   MN MA and Pmap realize that and don't require COB information on the claim.