Sunday, September 26, 2010

Item 9A - Medigap - How to fill in Medicare claims

In order to correctly process claims with Medigap information, Item 9A MUST be completed correctly. This means only Medigap information should be submitted in Item 9. Do not report a policy number for other types of insurance in Item 9. When preparing a Medigap claim, “Medigap”, “Mgap”, or “MG” MUST be in front of any policy number entered in Item 9A. Claims that do not meet this requirement run the risk of Medigap information not processing correctly. This may result in denials and/or incorrect payments.

Do not list other supplemental coverage in Item 9 and its subdivisions. Other supplemental claims (non-Medigap) are forwarded automatically to the private insurer if the private insurer contracts with the carrier to send Medicare claim information electronically. If there is no such contract, the beneficiaries must file their own supplemental claim.

Medigap policies must meet the statutory definition of a “Medicare supplemental policy” contained in Section 882(g)(1) of Title 18 of the Social Security Act and the definition contained in the NAIC Model Regulation, which is incorporated by reference to the statute. It is a health insurance policy or other health benefit plan offered by a private entity to those persons entitled to Medicare benefits and is specifically designed to
supplement Medicare benefits. It fills in some of the “gaps” in Medicare coverage by providing payment for some of the charges for which Medicare does not have responsibility due to the applicability of deductibles, coinsurance amounts, or other limitations imposed by Medicare.

Supplemental insurance are those plans offered by employers to employees, by labor organizations to
members or former members. Another example of coverage that is not a Medigap plan would be coverage for specified diseases or hospital indemnity coverage.

NOTE: Item 9D must be completed if a policy and/or group number is in Item 9A. Report the NAS assigned
Medigap PayerID or the Medigap insurance name.

The right way:

Box 9a - MGAP12345612
Box 9 b - MM DD YY X
Box 9c - M#### OR G####

In addition, the following items must be completed for Medigap claims.

Item 9B. Report the Medigap insured’s 8-digit birth date (MMDDCCYY) and sex.

Item 9C. Leave blank if a Medigap PayerID is entered in item 9D. Otherwise, the claims processing address of the Medigap insurer is shown. Use an abbreviated street address, two letter postal code, and zip code copied from the Medigap insured’s

Medigap identification card. For example:
1257 Anywhere Street
Baltimore, MD 21204
is shown as “1257 Anywhere St MD 21204.”

Item d- 1257 ANYWHERE ST MD 21204

1 comment:

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