PR 22 - This care may be covered by another payer

PR 22 This care may be covered by another payer per coordination of benefits.

Tips for avoiding this denial :

Denial indicates Medicare’s files show the patient has another insurance primaryto Medicare (called Medicare Secondary Payer or MSP).

• Before submitting a claim to Medicare:

• Have your patient complete the Medicare Secondary Payer (MSP) Questionnaire to help determine if Medicare is the primary or secondary payer.

• Check the patient’s eligibility, including if Medicare is a secondary payer, via the Part B interactive voice response (IVR) system.

If Medicare is secondary, the IVR will list the following MSP details:

1. Type of primary insurance

2. Effective and termination date for all valid Insurers for a current or previous date of service

• When a patient's file indicates Medicare is not the primary insurance, submit the claim to the primary payer; once it is processed, a claim can be submitted to Medicare for possible secondary payment. 

Tips to correct the denied claim

• Contact the patient to determine if any change has occurred in their insurance status. You can complete the Medicare Secondary Payer (MSP) Questionnaire to help determine if Medicare is primary or secondary.

• If so, update the insurance information on your files for all future claims.

• If you have information the patient's MSP file is incorrect, the patient and/or the provider should contact the Coordination of Benefits Contractor (COBC) to update the file.

• If the patient's file has been updated to reflect Medicare as primary on the date(s) of service, resubmit the claim to Medicare.

• If Medicare is secondary, submit the claim to the primary payer; once it is processed by the primary insurance, a claim can be submitted to Medicare for possible secondary payment.

Posted in: COB denial,Denial and action