I-Medicare Secondary Payer (MSP) yinxalenye ebalulekileyo yokuthumela amabango okufuneka aqondwe ngabahlawuli bonyango. Imithetho ingaba nzima. Iiofisi zonyango loo mali i-Medicare kufuneka iqinisekise ukuba abasebenzi babo abanoxanduva lokulungiselela nokuhambisa amabango baqeqeshwe kakuhle kwaye bahlale bekhulile kwizikhokelo nemimiselo. Cinga ngokuya kwiimviwo kunye namathuba.
Yintoni i-MSP?
I-Medicare Secondary Payer okanye i-MSP ibhekisela kwiintlawulo zeMedare xa i-Medicare engekho yinshuwalense eyona nto. I-Medicare idinga ukuba bonke abanikezeli bezempilo banikezele indlela yokuchonga xa i-Medicare yi-inshurensi yokuqala okanye eyesiqhelo kwiigulane zabo zeMedare.
Yazi ngeCWF
I-CWF okanye iFayile yoLuntu oluSebenzayo ngumsebenzi we-Medicare ogcina ulwazi malunga nokunika inkxaso kwabaxhamli be-Medicare . Qinisekisa ukuba uhlala uhlola i-CWF ukuze uhlaziye ulwazi lwe-MSP ukuze ufumane enye inkonzo yomshuwalense wezempilo.
Izigulane ze-Whom Medicare Ngaba i-Payer Primary
I-Medicare ngumhlawuli oyintloko umguli ohlangabezana nale mfuno:
- 65 okanye ngaphezulu kwaye unesicwangciso esithile sezempilo esincinane ngokusebenzisa umqeshi wakho wangoku okanye ngomqeshi waloo mlingane
- 65 okanye ngaphezulu nge-inshurensi ngokusebenzisa isicwangciso somhlalaphantsi
- Abakhubazekileyo kunye neqela lempilo elincinci ngokusebenzisa umqeshi wabo wangoku okanye ngomqeshi waloo mlingane
Izigulane ze-Whom Medicare yiNtlawulo yesiThili
I-Medicare yintlawulo yesibini yesigulane esichazela ezi mfuneko:
- 65 okanye ngaphezulu kunye necebo elikhulu lempilo yeqela ngokusebenzisa umqeshi walo wangoku okanye ngomqeshi waloo mlingane
- Ukukhubazeka kunye neqhinga elikhulu lempilo yeqela ngokusebenzisa umqeshi walo wangoku okanye ngomqeshi waloo mlingane
- Ikhutshwe nguMhlawulelo Wezabasebenzi
- Ihlanganiswa yintengiso yomshuwalense okanye yintlawulo yomshuwalense
Yintoni Oyenzayo Ngonyango Ukuba I-inshurensi yasePrayimari iyalahla isimangalo?
Kwimeko apho i-inshurensi eyinkuba iphika ibango, i-Medicare inokuhlawula kuphela izizathu ezithile zokungafuni, ezifana ne:
- Umgaqo-nkqubo womthengisi uphelile
- Imbuyekezo yomSebenzi inqume ukuba iinkonzo azifakwe
- I-inshurensi okanye i-inshurensi yemfanelo iyayiphika okanye ithatha ixesha elide ukuhlawula. Umniki-mali unakho ukufumana inkokhelo enemeko enyanzelekileyo ukuba ibango lilindelekile ukuba lithathe ixesha elibanzi lokuhlawula.
Ukusebenzisa imiqathango yeFL 18-28
Ikhowudi ye-02: Umgangatho unxulumene nomsebenzi
Ikhowudi 03: Umonde ogqityiweyo nge-inshorensi engabonakali apha
Ikhowudi ye-05: Ubuxoki bufakwe
I-Code 06: Isigulane se-ESRD kwiinyanga ezingama-30 zokuqala
I-Code 08: Umxhamli akayi kunika ulwazi malunga nolunye ukhuseleko lwe-inshurensi
I-Code 09: Akukho monde okanye umlingani oqeshwe
Ikhowudi ye-10: Umonde kunye / okanye iqabane liqeshwe kodwa akukho mphulo we-EGHP
Umgaqo-11: Abaxhamliweyo abakhubazekileyo kodwa akukho nkonzo ye-LGHP
Ikhowudi 28: I-EGHP yesineke kunye / okanye ye-EGHP yomlingane isibini
Ikhowudi 29: Abaxhamliweyo abakhubazekile kunye / okanye ilungu leentsapho ze-LGHP lisekondari kwi-Medicare
Ikhowudi 77: Umboneleli uyavuma okanye unyanzelekile / efunekayo ngenxa yesivumelwano okanye umyalelo wesivumelwano ukuba avumele ukuhlawulwa ngumhlawuli oyintloko njengentlawulo epheleleyo. Akukho ntlawulo yonyango iya kwenziwa.
Ukusebenzisa Iimpawu Iikhowudi FL 31-34
Ikhowudi ye-01: Ingxelo yokuhlawulwa kwezonyango
Ikhowudi ye-02: Akukho ntlawulo ye-inshorensi ebandakanyekayo (sebenzisa kunye nenani lexabiso 14)
Ikhodi ye-03: Inyathelo-yimboleko (sebenzisa ngekhodi yexabiso 47)
I-Code 04: I-accident-yengqesho ehlobene (sebenzisa ngekhodi yexabiso 15)
I-Code 06: Ixhoba lobugebengu
Umgaqo 18: Usuku lomhlala-phantsi / umxhamli lomhlalaphantsi
Umgaqo-19: Usuku lomlingani lomhlalaphantsi
Umgaqo-24: Usuku lwentsholongwane
Ikhowudi ye-33: Usuku lokuqala lokuqhagamshelana kwabakwa-ESRD abaxhamliweyo be-EGHP
Ikhowudi A3: Umhlawuli Iintlawulo ziphelile
Ukusebenzisa Amanani Amanani FL 39-41
Faka imali yokuhlawula i-Payer A e-FL 50 kwiikhowudi 12 - 43:
I-Code 12: Ukusebenzela umxhasi okanye umlingane
I-Code 13: Umxhamli we-ESRD kwinyanga ye-30 yokulungelelanisa
Umgaqo-14: Intshumo-ntle ye-inshorensi kuquka ne-auto
Ikhodi ye-15: Imbuyekezo yabasebenzi
Umgaqo-16: Inkonzo yempilo kaRhulumente okanye elinye iqumrhu lezemfundo elinjengexhoba lolwaphulaphulo, ilingo leziyobisi, njl njl.
Umgaqo 41: Umnyama umphunga
Ikhowudi 42: Ulawulo lwabadala
Umgaqo 43: Abaxhamliweyo abakhubazekile phantsi kweminyaka engama-65 kunye ne-LGHP
Ikhowudi 44: Umniki wemali uvumelekile ukuba wamkele kwi-payer oyintloko xa le mali ingaphantsi kweendleko kodwa ziphezulu kuneyona ntlawulo efunyenweyo, ngoko umrhumo wesibini weMedare. Faka isixa-mali esivumile okanye kufuneka uwamkele.
Ikhowudi 47: Inyuniti yemfanelo
Ukusebenzisa iikhowudi zobudlelwane FL 59
Ikhowudi 01: Mlingani
I-Code 04: Utata / ugogo
Ikhowudi 05: Umzukulwana / umzukulwana
Ikhowudi 07: Umtshana / umntakwabo
Ikhowudi ye-10: Umntwana onomntwana
Umgaqo 15: Iwadi
Ikhodi ye-17: uStepson / umzala
Umgaqo 18: Ukuzimela
Umgaqo 19: Umntwana
Umgaqo 20: Umqeshwa
Ikhowudi 21: Engaziwayo
Ikhowudi 22: Ukuxhomekeka kwabasebenzi
Ikhowudi 23: kuxhaswe kuxhaswe
Umgaqo-24: Uxhomekeke kumntu oxhomekeke kumntwana
Ikhowudi 29: Elinye iqhosha
Ikhowudi 32: Mama
Ikhowudi 33: Utata
Ikhodi ye-36: I-Emancipated encinci
Umgaqo 39: Umnikeli wombutho
Umgaqo 40: Umniki-mali
Umgaqo 41: Ummangali omelekileyo
Umgaqo 43: Umntwana apho i-insured ayinalo uxanduva lwemali
Ikhowudi 53: Iqabane loBomi
Ikhowudi G8: Olunye ulwalamano
Ndwendwela i- Medicare Claims Processing ku-website ye-cms.gov kwoluhlu olupheleleyo lwazo zonke iikhowudi zokuhlawula.