For any questions or concerns please contact the provider hotline toll free at 1-866-937-2783 option "1" between the hours of 8am to 4:30pm Monday through Friday (Central Time).
Balance Billing of Community Care Members
Per CMS and your contract with Community Care, you can not balance-bill our members.
CMS published, as did the Social Security Act (referenced within these publications) regarding QMBs (Qualified Medicare Beneficiary's).
In Summary:
- All our dual eligible members in PACE, Partnership and Family Care are QMBs
- Federal law prohibits providers from billing QMBs for Medicare deductibles, coinsurance, or copays for any Part A or Part B service (see Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), and 1848(g)(3)(A) of the Social Security Act [the Act])
- In states that have adopted a lessor of pay policy such as Wisconsin the state may limit their payment to the difference between the Medicaid rate and the amount Medicare has already paid which may result in no Medicaid payment if the Medicare paid amount is greater than the Medicaid allowed amount
- QMBs cannot elect to pay any Medicare deductibles, coinsurance, or copays