Medicare Eligibility Upcoming Release 12/8/2018

CMS has announced several upcoming changes to the Medicare eligibility response. The release is scheduled for 12/8 and the system won’t be available from 7:00 am  to 7:00 pm Saturday as they complete this release. I’ve listed a summary of the changes below but the complete release notes can be found here.

1. CMS will begin returning all diagnosis codes related to each Medicare Secondary payer enrollment period.
2. HCPCs codes for previously rendered  MDPP (Medicare Diabetes Prevention Program) services will be returned in  two circumstances:
   1. The NPI submitted on the eligibility request belongs to a MDPP supplier/vendor
   2. The eligibility request is sent with “Case Management” (CQ) as the service type

CMS may potentially return the following codes based on the beneficiaries previous usage: G9873, G9874, G9875, G9876, G9877, G9878, G9879, G9880, G9881, G9882, G9883, G9884, G9885, G9890 and G9891.

3. Medicare Advantage and Medicare Part D responses will begin returning the plan name if the plan benefit package (PBP) number is available. The PBP is the 3 digit code returned after the MCO/Part D contract number (H number).