CMS Pub. 100-05, ch. 2, § 10.8

A. Beneficiary's Responsibility with Respect to GHPs that are Primary to Medicare

The A/B MACs and DME MACs shall not make any Medicare payment if the

beneficiary has not filed a claim or cooperated fully with the provider, physician or other

supplier or the GHP. Also, the A/B MACs and DME MACs will not make any Medicare

payments until the beneficiary has exhausted the entire claims process. Conditional

benefits are not payable if payment cannot be made under the GHP because the

beneficiary failed to file a proper claim (See §100 of this chapter for definition of proper

claim) unless the failure to file a proper claim is due to mental or physical incapacity of

the beneficiary. [See CFR 42 § 411.165, 411.175 and 411.206]. A beneficiary need not

file any appeal if not inclined to do so.

B. Beneficiary's Right to Take Legal Action Against A GHP

Section 1862(b)(3)(A) of the Act provides that any claimant (including a beneficiary,

provider, physician, or supplier) has the right to take legal action against, and to collect

double damages from a GHP, that fails to pay primary benefits for services covered by

the GHP. Any claimant, also, has the right to take legal action against, and to collect

double damages from, a no-fault or liability insurer that fails to pay primary benefits for

services covered by the no-fault or liability insurer where required to do so under

§1862(b) of the Act.