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Gastroenterology Coding Alert

Reader Question:

Observe That Primary Payer Determination Uses Birthday Rule

Published on Tue Oct 09, 2012

Question: We recently made a claim for services provided to a minor patient by billing his mother's insurance. We received a call from the mother stating that we made a wrong claim as per the "birthday rule." The mother's birthday is 09/27/1977, and the father's birthday is 10/21/1973. The mother is of the opinion that we should have billed the father's insurance as he is older to her. What is the "birthday rule" and whose insurance should we have billed?Wisconsin SubscriberAnswer: You'll only follow the "birthday rule" in determining which parent's insurance is primary when the child is covered under the insurance plans for both parents. You'll find this rule typically applies to children whose parents are not separated or divorced, or dependent children of parents with joint custody.How it works: The birthday rule says that for a dependent child of parents who are not legally separated or divorced, the insurance [...]
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