Medicare AdvantageBilling CodesHigh impact
Medicaid coverage of Medicare cost sharing
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
For D-SNP (Dual-Eligible Special Needs Plans) members, providers must bill Medicaid for the 20% coinsurance on services like PCP visits, X-rays, specialist visits, and DME supplies. If you're not an approved Medicaid provider, you cannot bill the member for these cost-sharing amounts.
Action Required
By July 1, 2025: Billing team must update workflows to identify D-SNP members and automatically bill Medicaid (not the patient) for 20% coinsurance on PCP visits, specialist visits, X-rays, and Part B DME supplies. Update billing system to flag D-SNP claims and route cost-sharing to Medicaid. If practice is not an approved Medicaid provider, write off coinsurance amounts instead of billing patients. Train staff to recognize denial code MA1 and process accordingly.