What can I do if I receive Remittance Advice Details (RAD) code 171: Aid code 80 recipients (QMB) are restricted to Medicare coinsurance and deductible payments?
If the recipient is a Qualified Medicare Beneficiary (QMB ), verify that the claim is for Medicare deductible and/or coinsurance. Providers are reimbursed for Medicare non-covered services provided to a QMB recipient only when the recipient is eligible for Medi-Cal. Some Medi-Cal recipients may have additional eligibility once the Share of Cost (SOC) is cleared. For example, a recipient with both aid codes 80 and 17 (“Aged plus a Share of Cost”) has full coverage for Medi-Cal services after the Share of Cost requirement is met. Therefore, providers receiving Medi-Cal RAD code 171 should verify the recipient’s eligibility online before denying services. For more information, call the Telephone Service Center at 1-800-541-5555.
A. If the recipient is a Qualified Medicare Beneficiary (QMB ), verify that the claim is for Medicare deductible and/or coinsurance. Providers are reimbursed for Medicare non-covered services provided to a QMB recipient only when the recipient is eligible for Medi-Cal. Some Medi-Cal recipients may have additional eligibility once the Share of Cost (SOC) is cleared. For example, a recipient with both aid codes 80 and 17 (“Aged plus a Share of Cost”) has full coverage for Medi-Cal services after the Share of Cost requirement is met. Therefore, providers receiving Medi-Cal RAD code 171 should verify the recipient’s eligibility online before denying services. For more information, call the Telephone Service Center at 1-800-541-5555.
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