Secondary Liability Calculator

    Calculating Medicare's Secondary Liability Amount
    Calculation #1 

    OTAF Amount

    Billed Amount

    Primary Paid Amount

    If Non-Assigned Claim,
    Check Below

    If Non-Assigned, Enter Limiting Charge

    Press To Reset Form

    Result

    Perform Calculation #1

     

    Calculation #2 

    Psych Services

    Services That Pay 100%

    All Other Services

    Medicare Allowed Amount

    Medicare Allowed Amount

    Medicare Allowed Amount

    Deductible Applied


    Deductible Applied

    Date of Service



    Result

    Result

    Result

    Press To Reset Form


    Perform Selected Calculation #2

     

    Calculation #3 

    Medicare Allowed Amount

    Primary Allowed Amount

    Primary Paid Amount

    Press To Reset Form

    Result

    Perform Calculation #3

     

    The Lowest Amounting Resulting From Calculation #1, #2, Or #3 Is Medicare's Secondary Liability:
    $