Wednesday, May 4, 2016

CMS-1500 MEDICARE EOMB REQUIREMENTS secondary claim submission

   Medicaid requires an EOMB for all Medicare crossover claims filed on a paper claim.

** NOTE: Medicaid will reimburse Medicare Advantage Plans co-payments, coinsurance and deductibles, with the following exceptions:

We will not reimburse Medicare Advantage Plan claims for recipients deemed eligible for the Specified Low Income Medicare Beneficiaries (SLMB) Program. Combined co-payments and coinsurance may not exceed 20%. In order to ensure that claims are processed appropriately, the following information is required on the EOMB:

Requirements for EOMB Header:

** In the absence of identifying Medicare information on the EOMB, the provider must label the EOMB attachment “MEDICARE EOMB” to assure proper
processing of the claim.
** Provider Name
** Provider Medicare Legacy Number
** Provider NPI number
** Medicare Payment Date
** Column Headings (title)

Requirements for individual claim lines CMS-1500 Part B:

** Date of service
** Procedure code plus modifiers (up to 4 spaces for modifiers when applicable)
** Charged amount for each procedure
** Allowed amount for each procedure
** List deductible amounts (if any)
** List co-insurance amounts (co-pay amounts not payable)
** Patients Medicare ID number
** Total deductible amounts (if any)
** Total co-insurance amount
** Total Medicare payment (even if zero)

Note: If Medicare denies a service or claim, a written description of the reason/remark code(s) is required for all code(s).

Failure to comply with the above requirements will result in a denial of the claim and further delay in processing of the claim for payment. You may contact the Medicare Liaison Unit at 410-767-5559 for further assistance.

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