No-Fault Payment is Reduced Because Proper Claim Not Filed

30.2.1.3 - No-Fault Payment is Reduced Because Proper Claim Not Filed (Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23) When a provider receives a reduced no-fault payment because of failure to file a proper claim, (see Pub. 100-05, Chapter 1 for definition), the Medicare secondary payment may not exceed the amount that would have been payable if the no-fault insurer had paid on the basis of a proper claim. The provider must inform the A/B MACs and DME MACs that a reduced payment was made and notify it of the amount that would have been paid if a proper claim had been filed. Failure to notify Medicare of the latter amount would constitute the filing of a false claim against the United States and could result in prosecution.