TN 2 (10-22)

GN 02335.015 Carrier and Intermediary Actions in Underpayment Claims

When the carrier or intermediary receives notice of the enrollee's death while the enrollee's claim is being processed, or where an unnegotiated check has been returned, the carrier or intermediary determines from its records, or by contacting the physician, supplier, or provider, whether the services have been paid for. If a Part B claim filed by the enrollee was based on an unpaid bill, the carrier or intermediary will ascertain whether the physician, supplier, or provider wishes to claim the payment under the terms in GN 02335.020B.2.

If the physician, supplier, or provider does not wish to claim the payment, the carrier or intermediary, subject to the $50 tolerance in GN 02335.030B., will notify the survivors or estate of the deceased beneficiary of this and that Medicare payments may be made to a person who has assumed the legal obligation to pay the bill.

When the Part A or Part B services have been paid for, the carrier (or intermediary) will develop a claim for the underpayment (or request DO assistance) subject to the $50 tolerance in GN 02335.030B. When requesting assistance from the DO, the carrier identifies the information needed to establish the proper payee; e.g., a CMS-1490S or CMS-1450.