Medicare Advantage Plan Pricing Rules

This communication serves as an advisory notice for all Providers. The intent is to increase awareness of the Medicare Advantage Plan. The statement below should be used to gain further clarification regarding claims denied for Medicare Part C coverage.           

A Medicare Advantage Plan (also known as Medicare Part C or Medicare HMO) is a type of Medicare health plan offered by a private/commercial health insurance company that contracts with Medicare. The Medicare Advantage Plans covers the same services as the Medicare part A or B plan and is subject to the NCTracks Medicare crossover pricing rules. The difference is the Medicare Advantage Plan claims are edited as private/commercial health insurance secondary claims which may differ from the secondary Medicare part A and B claims editing.