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Medicare QMB Claims Processing Error- Action Required!

Attention Medicare Providers: We have been alerted to an issue by several of your peers regarding an issue with QMB Claims processing that will affect claims from October 2nd until December 8th. Details: If you had claims that were processed during this time, they may have received a new indicator that triggered Autoposting to post the payment, but reduce the claim line to zero by applying a second MAC W/O rather than creating COInsurance. The new indicator used during this time frame by DME MACs in your ANSI835 payment files is OA209, however because these claims are also paid, you will not be able to identify these claims using your Rejection Report because the response code was captured but not posted to the claim. What you need to do: These claims will need to be identified if you intend to bill the Medicare copay to the next payer or patient. Information from CMS is as follows: QMB Remittance Advice Issue On October 2, Change Request 9911 modified the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to identify QMB patients and reflect zero cost-sharing liability. This change resulted in unanticipated issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the RA. Beginning December 8, CMS systems will revert back to the previous display of patient responsibility for QMBs on RAs. You may want to hold QMB claims and submit them after December 8. See the QMB Program webpage for more information. Resolution Options: If you have claims that may be in this state, please contact Universal Support and we will log in to query your database and provide you with a list of claims that are in this state and need attention. Resolution Options: If you have claims that may be in this state, please contact Universal Support and we will log in to query your database and provide you with a list of claims that are in this state and need attention. (810) 653-5000 x 1   support@universalss.com