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Back  RFI # 1049: Medicare Supplemental 270/271

Formal vs. Informal Help Informal Formal

Submitter

Craig Keene

Description

We are attempting to determine a method to express to a provider in a 271 that a policy is a true Medicare supplemental policy and that no benefits are paid if Medicare does not cover a service. Is this a legitimate piece of information to be conveyed via a MSG segment? If not, is stating that a policy is a "Medigap" policy in EB04 sufficient to tell the provider that the policy is medicare supplemental and will not cover any services which are not covered by Medicare? Is there a need to express to the provider that the benefit percentages and amounts are based on Medicare's coinsurance and deductible, or are COB reimbursment calculation methods not necessary in the 271. I.E. 100% of Medicare's coinsurance is covered as opposed to a 0% coinsurance.

Submitter Assigned Keywords

270 271 true medicare supplemental

Response

The 271 2110C/D EB04 value of either MH (Medigap Part A) or MI (Medigap Part B) would be used to convey the Medicare supplemental policy insurance type. However, using these values in EB04 alone would not indicate the limitation that the policy will not cover any services which are not covered by Medicare. The values in EB01 in conjunction with the values sent in EB03 could be used to specifically outline which benefits are and are not covered by the Medigap policy. The 271 should not be used to send calculation methods as it’s not relevant to the response.

Recommendation

Usage of the MSG segment for the described scenario above is not recommended as it is basically conveying a generic statement that the Medigap supplemental policy will not cover benefits that Medicare wouldn’t provide some payment to cover. It would be a standard disclaimer as a part of a Medicare supplemental policy and should be outlined in trading partner agreements. It should not be sent in the 271.
Submission 5/19/2010
Status Date 7/30/2010
Status F - Final
Primary References
Document 005010X279
Section2.6
Page298
Set IDEB04