Provider, Physician, Other Supplier, and Beneficiary’s Responsibility with

40.2 – Provider, Physician, Other Supplier, and Beneficiary’s Responsibility with Respect to No-Fault Insurance (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) The provider, physician, other suppliers, and beneficiary (or the beneficiary’s representative) are responsible for taking whatever action is necessary to obtain any payment that can reasonably be expected under no- fault insurance. See 42 CFR §§ 411.50(c) and 489.20. Therefore, unless conditional payments can be made under § 40.7 of this Chapter, Medicare shall not make any Medicare payments until the provider, physician, other supplier, or the beneficiary has exhausted the entire claims process under no-fault insurance (unless the claim is disputed by the no-fault insurer, in which case Medicare is obligated to pay the claim, if properly submitted to Medicare). Conditional benefits are not payable if payment cannot be made under no-fault insurance because the provider, physician, other supplier, or the beneficiary failed to file a proper claim. (See Chapter 1, § 20 of the Medicare Secondary Payer Manual for definitions).