Knowledgebase: Claim Rejections
Medi-Cal MC051 - Bill Medicare first (FE418)
Posted by Will Morrow, Last modified by Charmagne Williams on 23 May 2017 03:16 PM
Rejection: Payer Specific Edit: Medi-cal should not be billed first when patient has Medicare. Bill Medicare first. If Medicare paid $0, then bill a Primary claim with Medi-cal as Primary, do not list Medicare. (FE418)

What happened: Medicare was listed as the 'other' payer in box 9d OR a secondary claim was sent where Medicare was the primary and paid zero (see attached picture below).

Resolution: Medi-Cal is always the secondary payer when a patient also has Medicare. For that reason, a primary claim cannot have Medicare listed as the 'other' payer in box 9d. Also, per Medi-Cal, if Medicare was billed first and paid nothing, instead of a secondary claim being billed to Medi-Cal, a primary claim needs to be billed to Medi-Cal and Medicare should not be listed on the claim anywhere.

 medicare 9d (secondary claim).jpg (39.03 KB)
 medi-cal payer name and paid amount.jpg (30.98 KB)