Provider Bills No-Fault Insurance First

30.2.1 - Provider Bills No-Fault Insurance First (Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23) 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. I f t h e r e i s n o t a n O R M o p e n r e c o r d a n d 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.