Deseret Alliance (Previously Deseret Secure) - Provider FAQ

General Questions

1. How will the billing process change?
   
   Previously, DMBA members covered by Medicare were enrolled in Deseret Secure, a Medicare Advantage Private Fee-for-Service plan. All claims were sent to DMBA and we paid the benefits for both Medicare and DMBA. Beginning January 1, 2013, DMBA members on Medicare will be enrolled in Deseret Alliance, a Medicare Supplement plan. Providers must send claims directly to Medicare. After Medicare processes the claim, the claim and Medicare’s payment information is automatically sent electronically to DMBA for processing. This is referred to as crossover billing. The electronic claims file is sent through Group Health Incorporated (GHI), the designated coordination of benefits contractor for Medicare claims.
2. When will the billing process change?
   
   For services rendered on or after January 1, 2013.
3. Will DMBA do crossover billing?
   
   Yes. The provider only has to submit their claim to Medicare. DMBA will receive an electronic claims file from Medicare every day, including claim and payment information, so we can take care of the additional benefits Deseret Alliance provides. All DMBA members covered by Medicare will automatically be set up for crossover billing.
4. Does Deseret Alliance coordinate with other plans?
   
   Deseret Alliance will coordinate benefits with Medicare Advantage (Part C) plans that do not include a prescription drug plan. But DMBA will NOT receive these claims electronically from Medicare. The provider will need to submit the claim to the Medicare Advantage plan first, and then the Medicare Summary Notice (MSN) and the claim must be sent to DMBA for processing.
   
   Deseret Alliance will not coordinate with other types of plans, such as Medigap plans or other Medicare Supplement plans.

Claims Submission

1. Where should I direct questions about claims for services rendered on or after January 1, 2013?
   
   Directly contact the respective company (DMBA or Medicare) for additional information about the way they processed the claim or their payment.
   • DMBA: 1-800-777-3622 or toll free at 801-578-5600.
   • Medicare: 1-800-MEDICARE
2. Where should I direct questions about claims for services rendered before January 1, 2013?
   
   
   • Through December 31, 2013, contact the Deseret Secure Provider Service Department (PGBA) at 1-877-220-0110.
   • Beginning January 1, 2014, contact DMBA at 1-800-777-3622 or toll free at 801-578-5600.
3. How long will claims processing take?
   
   Because Medicare holds most claims for a time before processing, claims will take longer to process than they have in the past. It’s important to note that DMBA cannot track or view claims until Medicare’s processing is complete. Typically, DMBA processes claims within 30 days of receiving the electronic claims file from GHI.
   
   Estimated Medicare hold time after the claim is received by Medicare:
   • Electronic claims: 14 days
   • Paper claims: 29 days
4. What happens with claims for services that begin in 2012 and end in 2013?
   
   

   Service	Description	Where to send the claim
   Inpatient Facility	Member is admitted inpatient to the hospital in 2012	DMBA
   Inpatient Provider	Services rendered in 2012	DMBA
   Inpatient Provider	Services rendered in 2013	Medicare
   DME	Claims with dates of service in 2012	DMBA

5. How will I know if a claim has been automatically sent to DMBA?
   
   If DMBA is the member’s only supplemental coverage, the Medicare remittance advice will show DMBA as the supplemental insurance. But if the member has a Medigap plan, as well as DMBA coverage, only the Medigap plan will show on the Medicare remittance advice. And the claim will still be forwarded to DMBA.
6. What if DMBA coverage is not listed on my Medicare remittance advice?
   
   If the Medicare remittance advice does not show DMBA as a supplemental insurance in the “Notes” section, send a copy of the remittance advice and a claim form to DMBA.
   
   
   DMBA
   PO Box 45530
   Salt Lake City, UT 84145-0530
   
   
   If you have any questions, call DMBA at 1-800-777-3622 or toll free at 1-801-578-5600.
7. Why do claims have to be submitted to Medicare first, even if Medicare doesn’t cover the service?
   
   Sending all claims to Medicare first ensures that Medicare considers all charges, including those for non-covered services, and pays their benefits for eligible services.
8. Will DMBA pay my late filing fee?
   
   No.