Billing WSI when Medicare is the Secondary Payer

February 2014

WSI has identified healthcare providers billing services to Medicare when WSI is the primary payer.

If an injured worker is a Medicare recipient and has a work related injury, WSI should be the primary payer. Medicare regulations require all entities, determine the beneficiary's primary insurance coverage, and then bill the appropriate payer.

Providers are required to wait for prompt payment from WSI prior to billing Medicare. Medicare defines prompt payment as120 days after WSI’s receipt of the bill. In the absence of prompt payment from WSI, providers must wait 120 days from the date of service to bill Medicare. For additional information on the MSP provision, visit www.cms.gov

If you have questions about this article, please send an email to wsipr@nd.gov.