What is the proper order of insurance claims sequence in healthcare?

The proper order of insurance claims sequence in healthcare is structured to maximize the chances of a claim being paid in full. The correct sequence typically starts with Medicare, followed by Commercial insurance, and then concludes with Medicaid.

Medicare is often the primary payer for eligible individuals, such as those over age 65 or individuals with certain disabilities. This makes it essential to process Medicare claims first, as it sets the baseline for payment.

Next, if there is a secondary or supplemental Commercial insurance policy, that insurer would then cover any remaining costs that Medicare does not pay. This could include deductibles or co-pays, ensuring that patients do not incur excess out-of-pocket expenses.

Finally, Medicaid serves as the tertiary payer. Because it is designed for low-income individuals and can cover remaining costs after Medicare and any Commercial insurance, it is processed last. In this situation, Medicaid may pay for services if the patient qualifies and if there are costs remaining after the first two layers of insurance have been applied.

This order ensures that healthcare providers receive the maximum possible reimbursement for services delivered, adhering to the policies governing each type of insurance.