Medicare AdvantageBilling CodesHigh impact
Provider News - February 2018
Security Health Plan·WI·Provider News
Effective date
Feb 1, 2018
We identified it
Jul 15, 2026
Summary
Security Health Plan has implemented a provider portal alert system to identify Medicare Advantage members with Qualified Medicare Beneficiary (QMB) status or full dual eligibility (Medicare/Medicaid). Providers must stop billing these members for Medicare Part A/B coinsurance, copayments, and deductibles, as federal law prohibits such charges. Providers should verify current Medicaid eligibility with Wisconsin or through CMS HETS before billing.
Action Required
Immediately upon receiving this notification: (1) Billing team must review all Medicare Advantage claims submitted to Security Health Plan to identify any charges to QMB or dual-eligible members for Medicare cost-sharing (copayments, coinsurance, deductibles). (2) Update billing system rules to flag or prevent billing Medicare A/B cost-sharing amounts to members with portal alerts indicating QMB status or full dual eligibility. (3) Train all billing and front-desk staff to recognize the new portal alert that states 'This member has/had Wisconsin Medicaid assistance in [year] and is potentially not responsible for any Medicare cost sharing.' (4) Implement process requiring staff to verify member's current Medicaid eligibility with State of Wisconsin or CMS HETS system before finalizing claims. (5) Review and adjust any pending claims already submitted with cost-sharing charges to QMB/dual-eligible members and resubmit corrected claims. Failure to comply with this federal requirement will result in improper billing violations and potential claim denials or recoupment by CMS.