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Medica Administrative Manual  >  Billing and Reimbursement > Medicare Estimation for Individual and Family Business (IFB) Claims 

Medicare Estimation for Individual and Family Business (IFB) Claims

Additional information may be required for IFB members' claims (this applies to Medica leased-network providers as well as direct-contracted providers).

As a reminder, when Medica believes that an Individual and Family Business (IFB) member may be Medicare-eligible, the claim will be processed as if Medica is the secondary payer. In certain instances, however, providers may be required to provide additional data elements to ensure that Medica can adjudicate the claim appropriately using Medicare payment methodologies. Any remaining balance would be considered member liability.



REV 11/2021

Date: 1/28/2023 5:05:35 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01