QMB Remittance Advice Adjustments

Provider/Supplier Type(s) Impacted: All Providers and Suppliers

Reason Codes: Remittance Advice Remark Codes (RARCs) N781, N782, and N783. Claim Adjustment Reason Code (CARC) OA-209

Claim Coding Impact: Not Applicable

Description of Issue: On 10/02/17, CMS Change Request (CR)9911, modified the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to identify QMB patients and reflect zero cost-sharing liability. This change resulted in unanticipated issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the RA.

Noridian Action Required: Noridian will initiate adjustments for QMB claims with dates of service prior to 12/07/17 that received the QMB messages implemented on 10/02/17. These adjustments will take place from May 2018 through September 2018. Claims will be adjusted in the order in which they were initially received.

Provider/Supplier Action Required: No action required. Suppliers will receive a new Remittance Advice (and beneficiaries will receive a new MSN) as a result of any of your claims which are adjusted. You do NOT need to contact the Contact Center regarding these claims.

Proposed Resolution/Solution: A mass adjustment will be initiated for claims impacted by CMS CR9911. For additional information, see CMS Medicare Learning Network (MLN) Matters (MM)10494 and Qualified Medicare Beneficiary (QMB) Program.

Date Reported: 4/13/18

Date Resolved:

Last Updated May 04, 2018