When you receive an Explanation of Reimbursement (EOR) with the message “Funds Exhausted, Bill Secondary,” it indicates that the available funds from the settlement for a work-related or liability injury have been depleted before the next annuity payment.
Immediate Steps to Take
At this point, you should reach out to your patient to gather information about their secondary insurance and proceed with resubmitting the claim. It's crucial to have the correct insurance details to ensure the claims process continues smoothly.
Handling Claims with Medicare
If your patient indicates that Medicare serves as their secondary insurance, submit the claim to Medicare, including a copy of the EOR. This documentation is necessary for proper processing by Medicare.
Ongoing Billing Practices
Even after receiving an EOR stating “Funds Exhausted,” continue to submit all future bills to CareGuard. This practice ensures you receive ongoing and correct EOR documentation for Medicare or other insurance providers. Once funds are replenished, CareGuard will automatically resume payments as the primary payer.
Final Details and Important References
For complicated scenarios or further guidance, consult the relevant insurance guidelines or reach out to your CareGuard contact for assistance. Continuing to follow these steps not only aids in claim processing but also prepares you for seamless transitions between insurance payers.
Maintain consistent communication with CareGuard and the patient to ensure all insurance details and claims submissions are accurate and updated.
