New Qualified Medicare Beneficiary (QMB) Information on the Provider Remittance Advice (RA)

Starting October 3, 2017, for original Medicare claims, the RA will identify QMB status and show $0 liability for periods during which the beneficiary is a Qualified Medicare Beneficiary (QMB). Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims. CR 9911 adds an indicator of QMB status to Medicare’s claims processing systems. This system enhancement will trigger notifications to providers (through the Provider Remittance Advice) and to beneficiaries (through the Medicare Summary Notice) to reflect that the beneficiary is enrolled in the QMB program and has no Medicare cost-sharing liability. Specific CARC and RARC codes will be provided on the RA indicating the beneficiary should not be billed. Effective November 4, 2017,HETS will indicate periods during which the beneficiary is enrolled in QMB and owes $0 for Medicare Part A and B deductibles and coinsurance.

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9911.pdf