Code of Federal Regulations Title 42. Public Health § 42.417.528 Payment when Medicare is not primary payer

(1) CMS may not pay for services to the extent that Medicare is not the primary payer under section 1862(b) of the Act and part 411 of this chapter.

(2) The circumstances under which an HMO or CMP may charge, or authorize a provider to charge, for covered Medicare services for which Medicare is not the primary payer are stated in paragraphs (b) and (c) of this section.

(1) The insurance carrier, employer, or other entity that is liable to pay for these services;  or

(2) The Medicare enrollee, to the extent that he or she has been paid by the carrier, employer, or other entity.

(1) The Medicare enrollee is covered under the plan;  and

(2) Under section 1862(b) of the Act, CMS is precluded from paying for the covered services.

(1) Identify payers that are primary to Medicare under section 1862(b) of the Act;

(2) Determine the amounts payable by these payers;  and

(3) Coordinate the benefits of its Medicare enrollees with these payers.