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Conditional Payment

A conditional payment is made when Medicare has knowledge that another insurer is, or may be, primary to Medicare and the payer will not make prompt payment (within 120 days), or has denied the claim for an acceptable reason. From a reimbursement standpoint, a claim paid conditionally will pay the same as if there was no insurance other than Medicare. Conditonal payments may only be made for Black Lung, Workers Compensation, and Accidents.