Skip to Main Content
Providers

Primary Payer Information for Medicare and Medicaid Products

Learn about claim submission details



  • Medicare is primary for all part A and B services
  • No Out-of-Network benefits (unless case of emergency)
  • If Medicare denies: Plan pays for routine screening procedures, preventive health services and state mandated services

For more comprehensive details, see the following resources:

  • Medicare is primary for all part A and B services
  • If Medicare denies; plan pays for state mandated services
  • Members may have purchased additional preventive non-Medicare covered health services (annual physical, eye exam, hearing exam, etc)

For more comprehensive details, see the following resources: 

  • Medica is primary for all Medicare and Medicaid-covered services
  • No Out-of-Network benefits (unless case of emergency)
  • All members are assigned a care system, but can receive care from any network provider within the service area

For more comprehensive details, see the following resources: 

  • For SNBC members who are not eligible for Medicare coverage; Medica is the only payer
  • For SNBC members who are eligible for Medicare; Medicare is the primary payer
  • No Out-of-Network benefits (unless case of emergency)
  • All members are assigned a care coordinator and can receive care from any network provider within the service area

For more comprehensive details, see the following resources: 

  • For in-network providers, Medicare is primary for all part A services, or any part B services billed on a UB-04. Medica is primary for all part B services billed on a CMS-1500.
  • For out-of-network providers, Medicare is primary for all part A and B services
  • In most cases, there are no out-of-network benefits (unless in case of emergency) within the Medica service area- Medicare is the only payer.
  • Out-of-network travel benefits apply outside of the Medica service area, Medicare is primary for all part A and B services, Medica will coordinate on all Medicare allowed charges

For more comprehensive details, see the following resources: 

  • Medica is primary for all part A and B services
  • No Out-of-Network benefits (unless case of emergency)

For more comprehensive details, see the following resources: 

  • Medica is primary for all part A and B services
  • Most Medicare-covered services are also covered out-of-network through Point-of-Service (POS) benefit.

For more comprehensive details, see the following resources: 

  • Medica is primary for all part A and B services
  • Members may receive coverage for both in-network and out-of-network services.

For more comprehensive details, see the following resources: 

  • For MSC+ members who are not eligible for Medicare coverage; Medica is the only payer
  • For MSC+ members who are eligible for Medicare; Medicare is the primary payer
  • All members are assigned a care coordinator and can receive care from any network provider within the service area
  • No Out-of-Network benefits (unless case of emergency)

For more comprehensive details, see the following resources:

  • Medica is primary for all Medicare and Medicaid-covered services
  • No Out-of-Network benefits (unless case of emergency)
  • All members are assigned a care system, but can receive care from any network provider within the service area

For more comprehensive details, see the following resources: 

  • Medica is primary for all part A and B services
  • No Out-of-Network benefits (unless case of emergency)
  • Coverage is limited to residents of contracted facilities who require, or are expected to require, an institutional level of care

For more comprehensive details, see the following resources: 

Date: 9/16/2021 4:07:28 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02