Last Modified: 10/3/2018 Location: FL, PR, USVI Business: Part A, Part B
Dual eligibility FAQ
Q: If a beneficiary is enrolled in Medicare and Medicaid, will Medicaid information be displayed in Benefits/Eligibility on the SPOT? Which one would be considered to be the primary payer?
A: No. If a beneficiary is enrolled in Medicare and Medicaid, information regarding Medicaid coverage will not be returned by HIPAA Eligibility Transaction System (HETS), which is the exclusive source for benefits and eligibility information on the SPOT.
Since Medicaid is a state-based, supplemental insurer, Medicare is always considered to be the primary payer.
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