RESOLVED: Adjustments to Qualified Medicare Beneficiary (QMB) Claims Processed Under CR 9911

Current Status
11/27/2018 Resolved: All adjustments have been completed for Jurisdiction J, M and Railroad Medicare.

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.

Provider Action:

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.  

What my remittance advice will look like with QMB non-monetary adjustments

  1. The PREV PAID amount on this claim adjustment is $319.80
  2. The PROV PD amount is $319.80
  3. The PROVIDER ADJ DETAILS: have a FB PLB for the adjusted claim for the PROV PD amount
  4. The payment for this claim is $0.00

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.

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 


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