Medicare AdvantageAdministrativeHigh impact
Qualified Medicare Beneficiary Program Mutual News Bulletin July 2018
Medical Mutual of Ohio·OH·In the News
We identified it
Jun 20, 2026
Summary
Medical Mutual clarified billing procedures for Qualified Medicare Beneficiary (QMB) Program members, who are dual-eligible Medicare Advantage and Medicaid patients. Providers are prohibited from collecting deductibles, copayments, or coinsurance from QMB members and must review remittance advice codes to identify and refund any wrongfully collected amounts.
Action Required
Immediately: Billing team must implement procedures to identify QMB status members using Medical Mutual Customer Care (1-800-362-1279) or CMS HETS system before collecting cost-sharing. Update billing software to flag QMB members and prevent collection of deductibles, copayments, and coinsurance. Train staff to recognize remittance advice remark codes N781, N782, N783, DE1, DE2, and DE3 indicating QMB status. Review patient accounts for any wrongfully collected amounts from QMB members and process refunds. Ensure non-discrimination policies prohibit refusing service to QMB members.