Medicare checks: connecting to Medicare, and Medicare fixes

Medicare checks work in Valian like any other carrier, with one difference: Medicare asks each practice to approve who checks eligibility for it. Your office does that once, for each NPI, and it takes about 10 minutes. Years of billing Medicare don't count for this: it is a separate approval.

Connect your office to Medicare

Until it is done, a Medicare check says Medicare is not connected. Every other carrier works right away.

What the Medicare card says

• Not connected: "One step left before Medicare checks work." Click Finish connecting to open the steps again.
• Connecting: "Medicare is confirming." We turn it on for you when Medicare confirms.
• Connected: Medicare checks work. Run any Medicare check that waited.

If Medicare did not confirm it, the card says so and goes back to Not connected, with the reason.

A Medicare check before you're connected

The fix on that check says "Medicare needs one step from your office first", with Finish connecting. Nothing on the patient's card is wrong, and a fix request can't clear it. Once Settings › Insurance shows Medicare as Connected, run the check again.

Medicare-specific fixes

• Medicare named by its office. Some practice software calls Medicare by the name of its regional office, such as "Novitas Solutions". On a patient's card, typing that name in the Carrier box brings up Medicare.
• A Medicare number saved under another carrier. At a medical office, when the member ID is a Medicare number but another company is picked, a line under the carrier box says: "This member ID is a Medicare number. Change the carrier to Medicare." A failed check says the same thing as its step 1. (Not on a Medicare Advantage or supplement card: those belong to their own company.)
• The birth date Medicare has. When a plan refuses the birth date but its answer carries the patient's Medicare number (many Medicare Advantage plans do), a connected office's fix opens with the date Medicare has already filled in: "Filled in with the date Medicare has." See A verification failed, what do I do?.
• A supplement on file. When the card on file turns out to be a supplement and Medicare (or another plan) pays first, a medical patient's page offers + Add primary plan. The supplement stays on file as the secondary. See Cards on file.

Medicare Advantage and supplement plans

A Medicare Advantage plan or a supplement is sold by its own company (for example Aetna or UnitedHealthcare). Pick that company from the card, not Medicare: those plans check like any other carrier and need no Medicare connection.

What Medicare allows

For Medicare patients, the estimate prices each code from Medicare's own fee schedule for your area, kept current for you. See Allowed amounts and fee schedules.

Frequently asked questions

We have more than one NPI. Medicare's approval is per NPI. Connect each NPI your checks run under.

We're a dental office. Should we connect Medicare? Medicare pays for almost no dental care, so a dental office checking a Medicare card sees No dental benefits on this plan. Ask the patient for their dental card.

Does connecting for checks also sign us up for Medicare claims? No. Checks, claims and payment letters are separate Medicare sign-ups. If Valian does your billing, we walk you through the claims sign-up in your dashboard.