US · guidance
CMS Pub. 100-05, ch. 3, § 30.1
Provider Billing Where Services are Covered by a GHP
Providers may seek reimbursement from a GHP insurer before billing Medicare when there is an
indication the insurer is primary payer. A GHP is billed first as primary payer even where there
may be primary coverage for only part of the stay or services (e.g., split stays where the
beneficiary terminated employment during the stay and the GHP coverage terminated
concurrently.)
When a provider bills a GHP as primary payer, the bill itemizes the services rendered even
though they are services for which Medicare reimburses on a fee schedule or other
reimbursement methodology.
History
(Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e73d677b21eaa3dca5bd9bee117bf5809fa7e60178b9bff181fb42dbd50fcf94
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