If you are billing Medicare Managed Care, please refer to the section called “Wisconsin Medicaid and Medicare Managed Care” found in this chapter. For more information on Medicare denials, refer to the "Reporting Other Insurance or Medicare Denials" section in this chapter.

Please note that not all providers are required to bill Medicare, even though the policyholder may have Medicare coverage. Do not enter a "Y" in the Medicare Ind box for the following provider types:

Nurses in Independent Practice.
Specialized Medical Vehicle.
Personal Care.
Dental.
School-Based Services.
Case Management.
Crisis Intervention.
Family Planning Clinics.

Depending on how Medicare reported their payment information to you, you must either report Medicare payments and adjustments on the Medicare tab (header level) or Srv Adj tab (detail level) in PES.

Look at the remittance advice that was sent to you by Medicare. If the payment information sent was reported at the header level, complete the Medicare screen in PES. If the payment information sent was at the service level, complete the Srv Adj tab. To access the Srv Adj tab, select "Y" in the Service Adjustment Ind box on the appropriate service tab. Do not complete both the bottom portion of the Medicare screen and the Service Adjustment screen for the same payer.

Please note that for each detail in which you wish to complete service adjustment information, you will need to highlight that service line and select "Y."

Next — Medicare Paid at the Header Level
Previous — Reporting Other Insurance Payments