US · guidance
CMS Pub. 100-05, ch. 3, § 30.2.1
Provider Bills No-Fault Insurance First
If the services are related to an automobile accident, the provider ascertains whether coverage
under no-fault insurance is available. If a provider learns that no-fault insurance may pay for
otherwise covered services, or if the beneficiary has an open ORM record, it must bill the
insurance company as primary insurer during the promptly period. If there is not an
ORM open record and i f the no-fault insurance will not pay promptly, the provider
shall bill the no-fault insurer first to get the denial. Once the denial is received on the
remittance advice, the provider may bill Medicare for conditional payment.
If no-fault insurance does not pay or does not pay in full and there is indication of primary GHP
coverage under Pub. 100-05, Chapter 2, the provider must bill the GHP for the services not paid
in full. It may bill Medicare for secondary benefits only after all primary payers to Medicare
have been billed.
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
e12d7e1bcd223e184b67871da37523da0e6030af886eba1bcf5702afaf9798fa
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