Open Enrollment - Beneficiaries Switching to a Medicare Advantage Plan

Many suppliers face claim denials citing a beneficiary's enrollment in a Medicare Advantage Plan. To minimize expenses associated with rework and denials, it is crucial to verify beneficiary’s eligibility on the Noridian Medicare Portal (NMP) before submitting claims.

Importance During Open Enrollment Periods

Verification becomes even more critical during specific times, especially during open enrollment periods. The Medicare Fee-for-Service (FFS) or original Medicare yearly open enrollment period, from October 15 to December 7, sees numerous beneficiaries opting to transition from FFS to a Medicare Advantage Plan (also known as Part C). Benefits for this switch commence on January 1 of next year.

Beneficiaries enrolled in a Medicare Advantage (MA) Plan have the flexibility to change their minds. They can either switch back to the original Medicare or opt for a different Medicare Advantage Plan during the Medicare Advantage Open Enrollment Period from January 1 to March 31.

These Medicare Advantage Plans, approved by Medicare and offered by private companies, provide an alternative to original Medicare, covering both Medicare Part A and Part B. Various types of Medicare Advantage Plans cater to diverse beneficiary needs.

Verifying Eligibility on the NMP

Ensuring that the correct payer is billed is paramount. The Noridian Medicare Portal features a dedicated tab for Health Maintenance Organization (HMO) or Medicare Advantage Plan verification.

When verifying eligibility through the HMO/MA tab, suppliers may obtain the following information:

  • Insurer Name
  • Plan Code Number
  • Effective and Termination Date
  • MCO Plan Type
  • MCO Bill Option Code
  • Address
  • Phone Number
  • Contract Website

This comprehensive verification process contributes to streamlined billing procedures, minimizing the risk of claim denials, and promoting an efficient and error-free healthcare reimbursement process.

Last Updated Dec 27 , 2023