GENERAL

1. How will I know if my client is a Medicare beneficiary?
2. How soon should the attorney contact Medicare?
3. Whom should the attorney contact to notify Medicare of a reimbursement situation?
4. How long should it take the attorney's office to receive an acknowledgment to their inquiry?
5. If more than one Medicare intermediary/carrier has a claim, which contractor should the attorney correspond with?
6. Should I expect any changes to the Medicare claim amount once the lead contractor has provided total claim information?
7. If I already know the dates of service applicable to my client's accident, should I contact Medicare for them to research their records?

1. How will I know if my client is a Medicare beneficiary?

   Anyone age 65 or over, or, with a disability (regardless of age) has the possibility of being a Medicare beneficiary. To verify a client's status as a Medicare beneficiary ask to see the client's red, white and blue Medicare card. Alternatively, the client may have a Medicare Summary Notice showing Medicare payments made on their behalf. The attorney should obtain all insurance information once representation is established.

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2. How soon should the attorney contact Medicare?

   It is the attorney's responsibility to immediately notify Medicare, in writing, once the attorney makes a decision to represent a Medicare beneficiary in an auto/liability case.

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3. Whom should the attorney contact to notify Medicare of a reimbursement situation?

   If you are starting a new auto/no-fault, liability, or workers' compensation case or have a general liability question, contact the Coordination of Benefits (COB) Contractor by phone or mail. This is a new process implemented by HCFA on January 8, 2001. Their Customer Service Representatives are available to provide you with quality service from 8:00 a.m. through 8:00 p.m., Eastern Standard Time, Monday through Friday. The toll free number is 1-800-999-1118 and their mailing address for written inquiries is: Medicare - Coordination of Benefits P.O. Box 660 New York, NY 10274-0660       When contacting the COB contractor, please provide the following: Your client's name Your client's Medicare or Social Security Number Date of incident Nature of illness/injury Name and address of the other insurance Any questions

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4. How long should it take the attorney's office to receive an acknowledgment to their inquiry?

   It will vary depending on how many requests are received, how many other contractors need coordinated with, and how old the accident is (whether or not the claim history is purged). You can expect it to take at least one month, and maybe longer. That is why we encourage attorneys to notify us as soon as you know your client is a Medicare beneficiary, rather than waiting so we can be developing the case before it is time for you to settle.

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5. If more than one Medicare intermediary/carrier has a claim, which contractor should the attorney correspond with?

   The attorney should always correspond with the COB contractor initially. The Medicare contractor who will assume the lead role is assigned by HCFA according to the state. Unlike the past, it may not be Highmark Medicare Services. All written or telephone communication should be with this contractor. Your check should also be sent to the lead contractor, who will then satisfy Medicare claim for the other involved contractors.

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6. Should I expect any changes to the Medicare claim amount once the lead contractor has provided total claim information?

   Yes, the Medicare claim could change quite often before actual settlement of the case. Medicare will perform periodic checks to determine if additional claims have been paid prior to settlement. Also, if you are aware of subsequent claims paid at the time of settlement, please inform the lead contractor.

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7. If I already know the dates of service applicable to my client's accident, should I contact Medicare for them to research their records?

   Yes, even though you may feel you have all dates of service related to the accident, Medicare must research their files to determine the total claim for all contractors.

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