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Printed Date: 9/22/2015
The services on the claim fall within or overlap a Medicare Advantage (MA) plan enrollment period.
Note: Managed care informational-only claims are not required for outpatient hospital or Inpatient Psychiatric Facility (IPF) services. If requesting a denial based on coverage by a managed care plan, submit the claim as covered without condition code 04 or 69.
If the beneficiary is enrolled in a managed care plan for only a portion of an inpatient stay, submit the claim as follows:
CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 11 (PDF, 4.8 MB), section 30.4.
CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 3 (PDF, 2.6 MB), section 20.3
CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 3 (PDF, 2.6 MB), section 20.8
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Last Updated: 01/10/2020