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Secondary Liability Calculator Print
Calculating Medicare's Secondary Liability Amount
Calculation #1

OTAF Amount

Billed Amount

Primary Paid Amount

If Non-Assigned Claim,
Check Below

If Non-Assigned, Enter Limiting Charge

Press To Reset Form

Result

Perform Calculation #1
Calculation #2

Psych Services

Services That Pay 100%

All Other Services

Medicare Allowed Amount

Medicare Allowed Amount

Medicare Allowed Amount

Deductible Applied


 

Deductible Applied

Result

Result

Result

Press To Reset Form


 

Perform Selected Calculation #2
Calculation #3

Medicare Allowed Amount

Primary Allowed Amount

Primary Paid Amount

Press To Reset Form

Result

Perform Calculation #3

The Lowest Amounting Resulting From Calculation #1, #2, Or #3 Is Medicare's Secondary Liability:
$

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