When Conditional Primary Medicare Benefits May Be Paid

20.7.1- When Conditional Primary Medicare Benefits May Be Paid When a GHP is a Primary Payer to Medicare (Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23) Conditional primary Medicare benefits may be paid if the conditions in the following subsection 20.7.2 do not apply and if one (1) of the following reasons apply [See 42 CFR § 411.175]: • The beneficiary, the provider, or their supplier that has accepted assignment has filed a proper claim under the GHP and the plan has denied the claim in whole or in part, or • The beneficiary, because of physical or mental incapacity, failed to file proper claim. When such conditional Medicare payments are made, they are made on condition that the GHP, and/or beneficiary, will reimburse Medicare if payment is subsequently made by the GHP.