KMAP BULLETIN: REMINDER: Claim Filing Indicator Code for Medicare or Medicare Replacement Plan

Date: 01/07/22

The following issue has been identified leading to this billing reminder. Providers are submitting their claims to the Managed Care Organizations (MCOs) using a Claim Filing Indicator Code other than MA (Medicare A) or MB (Medicare B) for members who have Medicare or Medicare Replacement Plan in the 2000B, SBR09 or 2320 loop/segment for web and electronically submitted claims. In addition, claims are being billed with a Claim Filing Indicator Code of MA or MB when the member does not have Medicare.

As a reminder to providers, when billing web or electronically, claims for a member with Medicare or a Medicare Replacement Plan, and being submitted to the MCOs or the Kansas Medicaid, the Claim Filing Indicator Code of MA (Medicare A) or MB (Medicare B) must be used. If not used, the claim will be denied with a message to bill either primary insurance or Medicare, whichever is appropriate. Using the Claim Filing Indicator Code of MA or MB ensures the claim is identified as a crossover claim and will process through the Medicare pricing algorithm appropriately.

The Medicare Advantage Plan (Part C) is private Health Maintenance Organizations (HMOs) contracted with the Centers for Medicare and Medicaid Services (CMS) to provide the minimum basic services covered under Medicare Parts A and B. These HMOs are sometimes referred to as Medicare Replacement plans. Claims filed with the MCOs and Kansas Medicaid as Fee-for-Service (FFS), must also be filed with a Claim Filing Indicator Code of MA or MB respectively.

For complete instructions, refer to the General TPL Payment Fee-forService Provider Manual.