Mandatory Insurer Reporting (NGHP)

Posted by:  :  Category: Medicare

Reporting is accomplished by either the submission of an electronic file of liability, no-fault, and workers’ compensation claim information, where the injured party is a Medicare beneficiary, or by entry of this claim information directly into a secure Web portal, depending on the volume of data to be submitted. Upon receipt of this information, CMS checks whether the injured party associated with the claim report is a Medicare beneficiary, and determines if the other insurance is primary to Medicare. CMS then uses this information in the Medicare claims payment process and, if Medicare paid first when it should not have, uses it to seek repayment from the other insurer or the Medicare beneficiary.
Source: cms.gov

Medicare Reimbursement Claims

Four years later the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) added more penalties for non-compliance to the Medicare Secondary Payer (MSP) Statute.  Section 111 of the MMSEA requires the providers of liability insurance (including self-insurance), no fault insurance and workers’ compensation insurance (hereinafter “insurers”) to determine the Medicare-entitlement of all claimants and report certain information about those claims to the Secretary of Health and Human Services.  The penalty for non-compliance with Medicare reporting standards is strict: $1,000 per day for each day the insurer is out of compliance.
Source: garretsongroup.com

MMSEA Section 111 Reporting

While there is no one-size-fits-all solution, most MEDVAL clients have made the strategic decision to develop their own internal capabilities for MMSEA Section 111 Reporting. MEDVAL is in optimal alignment with this approach, offering expert guidance, recommending appropriate protocols, and helping your staff execute your compliance strategy.
Source: medval.com

California Health Advocates: Medicare Policy, Advocacy and Education

Posted by:  :  Category: Medicare

» Ryan Coble from the Office of Inspector General will discuss durable medical equipment (DME) fraud. Topics include: common DME fraud schemes; DME case examples; and trends and hotspots. She will also discuss what SMPs, beneficiaries and their representatives can look for to detect DME fraud, and what information to provide the OIG when referring DME fraud cases. Due to the law enforcement sensitive information, this training will not be recorded. Register today!
Source: cahealthadvocates.org

Medicare Savings Programs

Medicare Part A premium. Note: Some people are required to pay a premium for Medicare Part A because they do not have enough Social Security credits. Most people do not pay a premium for Medicare Part A because they or their spouse earned enough credits by working 40 or more quarters (approx. 10 years of working full-time, four quarters per year). People who worked 30-39 quarters may buy Part A coverage and pay a monthly premium of $224 in 2015. People who worked fewer than 30 quarters may also buy Part A coverage and pay a higher monthly premium of $407 in 2015.
Source: cahealthadvocates.org

California Department of Aging

The California Department of Aging (CDA) administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the State. The Department administers funds allocated under the federal Older Americans Act, the Older Californians Act, and through the Medi-Cal program. The Department contracts with the network of Area Agencies on Aging, who directly manage a wide array of federal and state-funded services that help older adults find employment; support older and disabled individuals to live as independently as possible in the community; promote healthy aging and community involvement; and assist family members in their vital care giving role. CDA also contracts directly with agencies that operate the Multipurpose Senior Services Program through the Medi-Cal home and community-based waiver for the elderly, and certifies Adult Day Health Care centers for the Medi-Cal program. To find services in your community click here.
Source: ca.gov

Blue Medicare PPO and Blue Medicare HMO Providers

Posted by:  :  Category: Medicare

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
Source: bcbsnc.com

National Doctor and Hospital Finder

You can narrow your search by choosing from a range of criteria when you see your results, such as gender, accepting new patients, hospital affiliation. (The criteria vary depending on whether you’re searching for doctors, clinics, hospitals or other providers.)
Source: bcbs.com

Direct Mail Leads for Medicare Supplement, Final Expense and More

Posted by:  :  Category: Medicare

Send a mailer to the names available on our accurate and qualified lists using our turn key lead services. Names to mail with age and income selection, forms, printing, bulk rate outgoing shipping, response postage and handling, scanning, uploading and data entry into TLLM are all included in the price you are given. If you would like to select additional demographics or duplicate lists we can add those options to your order. All leads returned are EXCLUSIVE to you and your order. The households (not just the names) you mail are also protected for at least 90 days giving you plenty of time to receive and work your leads.
Source: targetleads.com

Medicare Direct Data Entry (DDE)

Say good-bye to modems, password re-sets, and disconnects. Manage your own MAC credentials, get support for multiple submitter IDs, and benefit from complete visibility to Medicare claim submissions and eligibility verification, with built-in EDI tracking capability.
Source: abilitynetwork.com

EmblemHealth: Family & Individual Health Insurance Plans In New York

To view this Web site, you need to have JavaScript enabled in your browser. Don’t worry — you can still sign in to the secure myEmblemHealth Web site or search for a doctor using the links below. If you need help registering for the secure site, please call Customer Service at the number on the back of your ID card.
Source: emblemhealth.com

What’s Medicare Supplement Insurance (Medigap)?

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

Retiree Health Benefits At the Crossroads

Posted by:  :  Category: Medicare

Prescription Drug Coverage.  With respect to prescription drugs, employer plans typically provide prescription drug coverage in conjunction with other medical benefits, and often these benefits are more generous than the standard Part D benefit (e.g., no coverage gap).  Employers have the option to provide prescription drug benefits directly through an  employer plan and receive a federal retiree drug subsidy (RDS) payment for offering qualified prescription drug coverage (that is, coverage that is at least equivalent to the Part D standard benefit).  Alternatively, the employer may contract with a Medicare Part D prescription drug plan (PDP) on a group basis to provide prescription drug coverage to Medicare-eligible retirees, for which the employer pays a negotiated premium in addition to what the PDP receives from Medicare under Part D.  Often the Part D plans receive a waiver from the Centers for Medicare and Medicaid Services (CMS) to provide coverage exclusively to the employer group and the employer plan separately supplements the Part D plan benefits, a combination known more technically as Medicare Part D Employer Group Waiver Plans (EGWP) plus Wrap.  Under these arrangements, employers contract with a Medicare Part D plan to provide benefits solely to the employer’s retirees, based on the standard benefit design, and the employer offers a secondary plan that supplements the first (waiver) plan to provide more generous drug coverage.
Source: kff.org

Compare Medicare Supplement Plans

Posted by:  :  Category: Medicare

For Texas residents. If a checkmark appears in a column of this Medicare Supplement chart, the Medigap policy covers 100% of the described medicare benefit. If a column lists a percentage, the medicare supplement policy covers that percentage of the described medicare benefit. If a column is blank, the medicare supplement insurance policy doesn’t cover that benefit.
Source: mysenioradvisorsgroup.com

How to compare Medigap policies

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Source: medicare.gov

Medicare Supplement Comparison Chart

Although there are several plans to choose from, comparing and contrasting Medicare Supplement Plans (also called Medigap) is relatively simple. The Centers for Medicare and Medicaid Services (CMS) has designed all Medicare Supplement Plans currently available. There are a total of 10 plans, and they are set up in a letter system ranging from “Plan A” to “Plan N”. All 10 Medigap plans are “Standardized”, meaning if you compared one particular letter plan, with another plan of the same letter offered by a different insurance company, the benefits would be identical. The only difference between companies is the price they charge.
Source: medicaresupplementsolutions.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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Source: medicare.gov

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Medicare Supplement Insurance Plan Benefit Comparison

*After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year. Plan K Out-of-Pocket Limit is $4,800.00. Plan L Out-of-Pocket Limit is $2,400.00. Out-of-pocket limit is the maximum amount you would pay for Co-insurance and Co-payments in a calendar year. The out-of-pocket annual limit will increase each year for inflation.
Source: medicaresupplementplans.com

Compare All Medicare Plan Options

Coverage is available to residents of the service area and separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* Blue Cross Blue Shield of Wyoming.*
Source: wellmark.com

Compare Medicare Supplement Insurance Plans & Medigap Plans and Rates for
2011. See Plan Chart for AL, AR, AZ, CO, FL, GA, IA, ID, KS, KY, LA, MD, MI, MO, MN, MS,
NC, NE, NM, OH, OK, SC, TN, TX, VA & WV. Medigap Insurance Plans including the
Popular Plan F & G

Year after year we have found Medicare Supplement Plan F or Medicare Supplement Plan G to be the best value for the dollar. The new Plan N is a great alternative to a Medicare Advantage plan.  Plan N might be recommended depending on which state you live in and how much the supplement cost in relation to available Medicare Advantage plans. A plan N will provide more coverage and a very reasonable premium. In Florida we have the lowest rate for plan F & plan N. See the Medicare Supplement Plan chart below. In general, the higher you go up in the plan chart the more Gaps the plan fills. Medicare Supplement Plan F is the most comprehensive supplement plan and there is not a better plan than F. Most people will select a Plan F. However, depending on your personal situation there may be a more cost efficient choice.
Source: themedicarechannel.com

Medicare Marketing Guidelines

Posted by:  :  Category: Medicare

The page could not be loaded. The CMS.gov Web site currently does not fully support browsers with “JavaScript” disabled. Please enable “JavaScript” and revisit this page or proceed with browsing CMS.gov with “JavaScript” disabled. Instructions for enabling “JavaScript” can be found here. Please note that if you choose to continue without enabling “JavaScript” certain functionalities on this website may not be available.
Source: cms.gov

Medicare Eligibility Guidelines

The patient has either of the following: a) Current pressure ulcer or past history of a pressure ulcer on the area of contact with the seating surface; or b) Absent or impaired sensation in the area of contact with the seating surface or inability to carry out a functional weight shift due to one of the following diagnoses: spinal cord injury resulting in quadriplegia or paraplegia (344.00-344.1), other spinal cord disease (336.0-336.3), multiple sclerosis (340), other demyelinating disease (341.0-341.9), cerebral palsy (343.0-343.9), anterior horn cell diseases including amyotrophic lateral sclerosis (335.0-335.21, 335.23-335.9), post polio paralysis (138), traumatic brain injury resulting in quadriplegia (344.09), spina bifida (741.00-741.93), childhood cerebral degeneration (330.0-330.9), Alzheimer’s disease (331.0), Parkinson’s disease (332.0).
Source: mobilitycare.com

Medicare Policies and Guidelines

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Source: findacode.com

Prostate cancer screenings

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
Source: medicare.gov

Medicare Supplement Plans & Quotes

Posted by:  :  Category: Medicare

Turning 65 is stressful, and the amount of information people receive leading up to their birthday is astounding. From the stacks of mail piling up on your desk, to the seemingly endless phone calls and quotes from insurance companies and agents, the task of gathering honest, unbiased information can feel impossible. Our goal is to offer what nobody else will, which is why we provide medicare supplement quotes, financial ratings, benefit information, application fee data, price history, and pricing methodology for all supplemental insurance companies in one clean, concise report. Our free, no obligation service is designed to give you the information you need regarding Part D and Medicare Supplement Plans in order to make an educated purchasing decision. In addition, we offer continued support for all of our customers to ensure they have no claims or billing issues. On an annual basis we review all medicare supplement insurance quotes and plan options in an effort to notify our customers of any new or better plans that may be available.
Source: medicaresupplementshop.com

Compare Medicare Supplement Plans

For Texas residents. If a checkmark appears in a column of this Medicare Supplement chart, the Medigap policy covers 100% of the described medicare benefit. If a column lists a percentage, the medicare supplement policy covers that percentage of the described medicare benefit. If a column is blank, the medicare supplement insurance policy doesn’t cover that benefit.
Source: mysenioradvisorsgroup.com

Best Medicare Supplement Insurance Quotes

Every Medicare supplemental insurance plan must follow federal and state laws designed to protect you. Medicare supplement plan insurance companies can only sell you a “modernized” Medicare supplemental insurance plan identified by letters A through N. Each modernized Medicare supplemental insurance plan must offer the same basic benefits, no matter which insurance company sells it.
Source: medicaresupplementplans.com

Compare Medicare Supplement Plans 2015Compare Medicare Supplement Plans 2015

With ever increasing numbers of people turning 65 and needing Medicare health care benefits, the choices are numerous. Is a Medicare Supplement plan the best option, or perhaps a Medicare advantage plan? Several people have turned to supplemental insurance for Medicare Part A and Part B and have been extremely happy with their coverage. We’ll help you to compare Medicare Supplement Plans in 2015 so you can choose the best coverage to fit your needs, as well as not overpay for it.
Source: comparemedicaresupplementplans2015.com

Compare Medicare Supplement Plans A

If an insurance company wants to sell Medicare Supplement Insurance, they are required by law to offer Medigap Plan A. If they wish to offer any additional plans, then they must sell either Plan C or Plan F in addition to any other plans they would like to sell. Providers do not have to offer every Medicare Supplement plan.
Source: ehealthinsurance.com

Compare Medicare Supplement Insurance Plans

Every Medicare supplemental plan must follow federal and state laws designed to protect you. Medicare supplement plan insurance companies can only sell you a “modernized” Medicare supplemental plan identified by letters A through N. Each modernized Medicare supplemental plan must offer the same basic benefits, no matter which insurance company sells it.
Source: medicaresupplementplans.com

Medicare Supplement Plans

To be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B. The best time to enroll in a plan is during the Medigap Open Enrollment Period, which begins on the first day of the month that you are both age 65 or older and enrolled in Part B, and lasts for six months. During this period, you have the guaranteed issue right to join any plan of your choice, meaning that you may not be denied coverage based on any pre-existing conditions. If you miss this enrollment period and attempt to enroll in the future, you may be denied coverage based on your medical history.
Source: ehealthinsurance.com

Fidelis Care Health Insurance

Posted by:  :  Category: Medicare

Fidelis offers health plans for individuals, Medicare eligible beneficiaries and Medicaid eligible people. They provide free or low-cost health insurance through a variety of health programs that help cover preventive care, prenatal care, labs and immunizations, emergency care, and more.
Source: healthplanone.com

Medicare Prescription Drug Coverage (Medicare Part D)

Medicare sets standard costs for the prescription drug benefit each year. Private companies approved by Medicare offer plans with different costs and selections of prescription drugs. You can select a plan based on the prescriptions you take and select a company that is most effective for you. To reduce your costs, enter your medications on Medicare’s secure online Find health and drug plans website. You will pay more if your prescriptions are not in the plan formulary or the plan restricts or limits their use.
Source: texas.gov

Medicare.gov Physician Compare Home Page

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Find & compare doctors, hospitals, & other providers

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Supplemental, Advantage, and Part D Plans

Because of the significant amount of out-of-pocket payments required by traditional Medicare, a booming market of private-sector insurance products has grown up around the government programs. These Medicare-related insurance products are one of the fastest-growing segments of the U.S. health insurance industry overall. And they are the part of the market on which a smart consumer should focus his or her attention. Medicare Providers mission is to help seniors understand these products and provide tools assist in the decision making process.
Source: medicare-providers.net

Coventry Medicare: Locate A Provider

Need to find a provider?  Our online provider search tools give you flexibility in a simple format.  Just select the type of provider you are looking for from the links below and be connected to the appropriate search tool.
Source: coventryhealthcare.com

Medicare Unmasked: Behind the Numbers

This project uses data made public by the Centers for Medicare and Medicaid Services. It shows the dollar amounts that doctors and other medical providers received in Medicare reimbursements in 2012 and 2013, along with other data including their specialties. Only procedures which providers performed on more than 10 Medicare patients were included in the data released. There is some information CMS hasn’t provided. In some cases, procedures attributed to a specific physician may have been performed by other people under that doctor’s supervision. The data doesn’t include information on patients nor does it show doctors’ billings related to durable medical equipment.
Source: wsj.com

Blue Cross Medicare Advantage Providers

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Source: bcbsnm.com