New RARC codes will identify Medicare Qualified Member Beneficiaries

Last fall, CMS initiated the use of Remittance Advice Remark Codes (RARCs), which indicate on the remittance advice that the member is a Qualified Medicare Beneficiary (QMB), also known as  dual-eligible for Medicare and Medicaid. 

Priority Health has chosen to align with CMS methodology and use the same RARC codes to identify QMB members on a remittance advice.

New codes still scheduled for March

Although CMS announced in December 2017 they were temporarily halting use of these RARC codes due to unforeseen impact on secondary insurance processing, Priority Health does not have the same issue. We will begin using these codes in March 2018.

As appropriate, you'll see one or more of the following new codes on remittance advices for QMB members:

N781 – No deductible may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments.

N782 – No coinsurance may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments.

N783 – No co-payment may be collected as patient is a Medicaid/Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance, deductible or co-payments.

How to identify QMB members

Priority Health has updated our Member Inquiry tool to include a header for QMB. If a member is a QMB, it will now clearly state Yes. You can also identify QMB members by using:

Billing QMB members

Priority Health would like to remind providers of their financial obligation to manage QMB members differently than general Medicare members.

The QMB program is a State Medicaid benefit that covers Medicare premiums and deductibles, coinsurance, and copayments, subject to State payment limits. Medicare providers may not bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts.

Further, Medicare providers must accept the Medicare payment and Medicaid payment (if any) as payment in full for services rendered to a QMB beneficiary. The member cannot be billed for any remaining balance.

Questions?

For additional information about the QMB program and money recovery, see:

Access to Care Issues Among Qualified Medicare Beneficiaries (QMB)

MLN Matters® Number: SE1128: Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program