RFI #
1826
Value SBR09 for Medicare HMO
Description
Can MB or MA be used to identify that Medicare HMO is the payor in the SBR09 or must it be 16?
RFI Response
When the claim is billed to a Medicare HMO, code "HM" Health Maintenance Organization should be used in SBR09. If billed to a Medicare Risk Based HMO, code "16" Health Maintenance Organization (HMO) Medicare Risk should be used. Codes "MB" and 'MA" should be used when billing traditional Part B and Part A Medicare.
DOCUMENT ID
005010X222