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Recent changes to CMS requirements and additions to Medicare Advantage Addendums 

November 12, 2018    

Attention! Updates have been made to this article.

In accordance with the Amendment provision of your Participating Provider Agreement (Agreement), Independence is providing you with notice of the regulatory changes required under your Medicare Advantage Addendum which is attached as an Exhibit to your Agreement. The below changes are required to comply with all current Centers for Medicare & Medicaid Services (CMS) rules and regulations.

New provisions

Effective immediately, the following new provisions are added to the Medicare Advantage Addendum as follows:

Non-Covered Services

Participating Provider shall not bill Medicare Advantage Members for items or services that are not Covered Services, unless, prior to furnishing the item or service, Participating Provider requests from Independence prior authorization, and Participating Provider and the Medicare Advantage Members receive a written denial. Participating Provider acknowledges that CMS guidance states that Advance Beneficiary Notices (ABNs) cannot be used for Medicare Advantage Members. In order to bill Medicare Advantage Members for non-Covered Services, Participating Provider must first obtain from Independence an organization determination as addressed in 42 CFR 422.566.

Enrollment Advice

Participating Provider shall remain neutral to the extent Participating Provider assists any beneficiary with Medicare enrollment decisions.

More information

For a complete copy of the new Medicare Advantage Addendum, please complete our online form and indicate that you would like a copy of the Addendum in the comments section. If you have additional questions, please call 1-800-ASK-BLUE.

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