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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

August 2018

QMB Members Cannot be Billed for Medicare Parts A and B Cost-Sharing

As you may be aware, the Qualified Medicare Beneficiary (QMB) program put in place by the Centers for Medicare and Medicaid Services (CMS) assists low-income Medicare beneficiaries with Medicare Part A and Part B premiums and cost-sharing, including deductibles, coinsurance, and copayments. Under the QMB program, enrollees are exempt from cost-sharing liability, so all providers must refrain from charging QMB members for Medicare cost-sharing for covered Parts A and B services.
Identifying members with QMB status

CMS’s HIPAA Eligibility Transaction System (HETS) provides Medicare eligibility data to providers and their authorized billing agents (including clearinghouses and third-party vendors) to help verify a patient’s QMB status and exemption from cost-sharing charges. Contact your third-party eligibility verification vendor to ask how their products reflect the new QMB information from HETS. Alternatively, you can contact Harvard Pilgrim’s Medicare Advantage Provider Service Center at 888-609-0692 to learn the best way to identify the QMB status of your patients.

More information

For more detailed information about CMS’s QMB program, please refer to this document from the Medicare Learning Network, as well as the Billing Members policy in Harvard Pilgrim’s Medicare Advantage Provider Manual.

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Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator