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.
- CMS will begin returning all diagnosis codes related to each Medicare Secondary payer enrollment period.
- HCPCs codes for previously rendered MDPP (Medicare Diabetes Prevention Program) services will be returned in two circumstances:
- The NPI submitted on the eligibility request belongs to a MDPP supplier/vendor
- 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.
- 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).