Medicare HETS 270/271 Submitters:
The HETS 270/271 system utilizes a variety of 271 2110C EB04 Insurance Type Codes to identify different types of Managed Care Organizations (MCOs). HETS 270/271 currently utilizes a 271 2120C NM101 value of "PRP" for all of these different MCOs. HETS should be returning a 271 2120C NM101 value of "PR" for Medicare Advantage HMO non-risk plans. Medicare Advantage HMO non-risk plans are identified by 271 2110C EB04 Insurance Type Code "HM".
CMS will modify HETS to return the correct value in the 271 2120C NM101 value for Medicare Advantage HMO non-risk plans. In the interim, submitters should contact the Medicare Advantage HMO non-risk plan for information regarding appropriate claim filing information.
Please contact the Help Desk if you have any questions or comments.
Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk