A reference tool has been developed to simplify the application of Medicare Secondary Payer rules and help identify the primary claims payer in most Medicare situations. Four criteria are used to determine whether a company’s plan or Medicare is the primary or secondary payer:

• total number of employees
• reason for Medicare entitlement
• subscriber’s employment status
• plan paying primary prior to End Stage Renal Disease (if applicable)

Key rules and the criteria are explained on the reverse side of the matrix