September 2017
Blue Cross Medicare AdvantageSM Providers are Prohibited from Billing Dually Eligible Individuals Enrolled in the QMB Program
As a reminder, the independently contracted providers participating in the Blue Cross Medicare Advantage (PPO)SM (MA PPO) and/or Blue Cross Medicare Advantage (HMO)SM (MA HMO) member products may not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare cost-sharing. QMB is a Medicare Savings Program (MSP) that exempts Medicare beneficiaries from Medicare cost-sharing liability.
Please ensure that you and your staff are aware of the federal billing law and policies regarding QMB individuals. All MA PPO and MA HMO providers should ensure that their billing software and administrative staff exempt QMB individuals from Medicare cost-sharing billing and related collection efforts. Providers who inappropriately bill QMB individuals are subject to sanctions.
The QMB program is a State Medicaid benefit that covers Medicare premiums and deductibles, coinsurance and copayments, subject to State payment limits. MA PPO and MA HMO providers may not bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses the providers for the full Medicare cost-sharing amounts.
Contact Customer Service at 877-774-8592 to learn about ways to identify QMB patients and procedures applicable to Medicaid reimbursement for their Medicare cost-sharing. For additional information, read the full Centers for Medicare & Medicaid Services (CMS) notice.
This is a brief description of some of the terms of the MA PPO and MA HMO plans. For more details, please refer to the applicable MA PPO or MA HMO plan document.