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Printed Date: 9/22/2015
Issue Identified 3/16/2018
CMS has instructed Medicare Administrative Contractors (MACs) to initiate non-monetary mass adjustments for claims impacted by CR 9911 Qualified Medicare Beneficiary (QMB) remittance advice (RA) changes. This includes claims that were paid after October 2, 2017 and up to December 31, 2017, and that have not been voided or replaced. The goal is to produce replacement Medicare RAs that providers can submit (when appropriate) to supplemental payers to coordinate benefits as necessary.
11/27/2018 Resolved: All adjustments have been completed for Jurisdiction J, M and Railroad Medicare.
11/19/2018: Palmetto GBA has completed 80 percent of the adjustments required for Jurisdiction J.
10/31/2018: Jurisdiction J (JJ) adjustments continue. Palmetto GBA has completed 698,878 of the more than 1.3 million required claim adjustments for JJ.
9/14/2018: Jurisdiction M and Railroad claim adjustments have been completed. Jurisdiction J adjustments are ongoing.
4/30/2018: No action is required on claims that secondary payers successfully processed through direct claims submission or the Coordination of Benefits Agreement (COBA) process. Although mass-adjusted claims may not cross over, providers may use the new RAs to resubmit State Medicaid QMB cost-sharing claims that states initially failed to pay due to CR 9911 QMB RA changes. This CPIL will be updated when all adjustments have been completed which will be on or before December 20, 2018.
What will my remittance advice look like with QMB non-monetary adjustments?
*Note: If you receive an electronic remittance advice (RA) from your vendor in a format other than what is listed below, ask your vendor to identify these items within your vendors RA format.
As directed by the article on the Palmetto GBA website, this RA may be used to resubmit State Medicaid QMB cost-sharing claims that states initially failed to pay due to CR 9911 QMB RA changes.
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Last Updated: 11/27/2018