Medicare as Secondary Payer: the EOB

When Medicare is the secondary payer, you must first submit the claim to the primary insurer. If, after processing the claim, the primary insurer does not pay in full for the services, you can submit the claim to Medicare electronically or via a paper claim for consideration of secondary benefits.

The Medicare paper claim must include a copy of the primary insurer’s explanation of benefits (EOB). If the patient is covered by more than one insurer primary to Medicare, you must submit the EOB from both plans with the Medicare claim.

When sending a Medicare-as-secondary-payer claim electronically, you do not need to separately send the EOB from the primary insurance.

See the Medicare A/B Reference Manual, Chapter 11 — Medicare as Secondary Payer (MSP) (PDF).

Updated Aug. 19, 2013 


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