Instructions for Beneficiaries Enrolled in Medicare Managed Care Plans

Billing guidelines previously published in the November 2009 and January 2010 Medicaid Update instructed providers to use Claim Filing Indicator Code 16 to bill Patient Responsibility amounts to Medicaid following payment from a Medicare Advantage Plan. Since these instructions were issued, claims have been submitted to Medicaid using Claim Filing Indicator Code 16 for Medicaid beneficiaries who were not enrolled in a Medicare Advantage plan. Therefore, effective December 1, 2012, all claims indicating Medicare Advantage plan coverage (Claim Filing Indicator Code 16), must have an active Medicare Advantage Plan in the eMedNY system for the date of service, or the claim will be denied. The denial message will read “Pyr 16 Invalid- Client Not Enrol In MCARE Advant.”