If you become aware that you have been paid primary by Medicare in error, you
must refund the overpayment to Medicare.
The following information must be included when making a refund to Medicare.
If it is not possible to send all of the information, send as much as possible.
Please provide the following:
- A copy of the Medicare payment report showing the claims involved. If a
copy if not available, please provide the Medicare number of the patient and
the dates of service involved.
- A copy of the primary insurer’s Explanation of Benefits.
- The primary insurer’s Explanation of Benefits must be complete and
legible.
- It should contain all column and header information, as well as remark
codes and explanations of the remark codes.
- If the Explanation of Benefits is for an adjusted claim, we will also
need the Explanation of Benefits for the original claim.
For auto, no-fault and workers compensation insurance a copy of the payment
log or PIP list is also needed. Please include the name and address of the
insurance company and attorney handling the case.
- The name of the insured person and his/her relationship to the Medicare
beneficiary (for example, husband, wife, father, mother).
Please also provide a copy of the insured’s insurance card and the effective
date of the primary insurance policy.
