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HOAX MEMORIAL HOSPITAL PRESBYTERIAN MEDICARE SECONDARY PAYER QUESTIONNAIRE Patients Name: Date: Question Circle one #1 Is the patient covered by an employer group health plan (EGP) either through

How to fill out ps 138 medicare secondary

How to fill out PS 138 Medicare Secondary:

1. Obtain the PS 138 form: The PS 138 form, also known as the "Medicare Secondary Payer Explanation of Benefits" form, can be obtained from your healthcare provider or insurance company. You may also be able to download it online.
2. Complete personal information: Start filling out the form by providing your personal information such as your name, address, date of birth, and Medicare number. This information helps identify you as the Medicare beneficiary.
3. Provide details of the primary payer: In the form, you need to indicate the details of the primary payer, which is the insurance plan that pays first before Medicare. Fill in the name, address, and any identification numbers associated with the primary payer.
4. Explain your situation: Use the form to explain why Medicare is considered the secondary payer. This can include situations where you have coverage through an employer, workers' compensation, or any other condition that makes Medicare secondary.
5. Attach supporting documents: If applicable, attach any supporting documents that validate the primary payer's responsibility for payment. This can include copies of insurance cards, Explanation of Benefits (EOB) statements, or any other relevant documents.
6. Review and sign: Before submitting the form, review all the information provided to ensure accuracy. Once verified, sign and date the form.
7. Submit the form: After completing and signing the form, follow the instructions on where and how to submit it. This may involve mailing the form to the appropriate address provided or directly providing it to your healthcare provider.

Who needs PS 138 Medicare Secondary?

1. Medicare beneficiaries with primary coverage: The PS 138 form is typically required for individuals who have primary health insurance coverage through sources such as an employer-sponsored plan, union coverage, or veterans' benefits. Medicare will act as the secondary payer in these situations.
2. Individuals with workers' compensation claims: If you have a workers' compensation claim due to a job-related injury or illness, Medicare may be the secondary payer. This means you would need to fill out the PS 138 form to explain your situation accurately.
3. Those with other insurance arrangements: Some individuals may have additional insurance arrangements, such as liability insurance or no-fault insurance, which could make Medicare the secondary payer. In such cases, the PS 138 form is necessary to provide the required information.

Note: It is important to consult with your healthcare provider or insurance company for specific guidance on filling out the PS 138 form and determining whether you need it based on your unique circumstances.

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What is ps 138 medicare secondary?

PS 138 Medicare Secondary is a form used to report information about Medicare beneficiaries who have other health insurance coverage.

Who is required to file ps 138 medicare secondary?

Healthcare providers who provide services to Medicare beneficiaries with other health insurance coverage are required to file PS 138 Medicare Secondary.

How to fill out ps 138 medicare secondary?

PS 138 Medicare Secondary can be filled out electronically or on paper. Providers must report information about the other health insurance coverage the beneficiary has.

What is the purpose of ps 138 medicare secondary?

The purpose of PS 138 Medicare Secondary is to coordinate benefits between Medicare and other health insurance coverage for Medicare beneficiaries.

What information must be reported on ps 138 medicare secondary?

Information such as the name of the insurance company, policy number, and group number must be reported on PS 138 Medicare Secondary.