RFI Browser

Back  RFI # 1826: Value SBR09 for Medicare HMO

Formal vs. Informal Help Informal Formal

Submitter

Canady Donna

Description

Can MB or MA be used to identify that Medicare HMO is the payor in the SBR09 or must it be 16?

Response

When the claim is billed to a Medicare HMO, code "HM" Health Maintenance Organization should be used in SBR09. If billed to a Medicare Risk Based HMO, code "16" Health Maintenance Organization (HMO) Medicare Risk should be used. Codes "MB" and 'MA" should be used when billing traditional Part B and Part A Medicare.
Submission 7/12/2013
Status Date 8/21/2013
Status F - Final
Primary References
Document 005010X222
Section2
Page298
Loop2320
Segment Position09
Segment IDSBR