skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 12/13/2017 Location: FL, PR, USVI Business: Part A, Part B

HETS application: Updated MSP insurance type codes and inclusion of QMB data

The Centers for Medicare & Medicaid Services (CMS) released several changes to the Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS), which went into effect November 4, 2017. The changes impacted providers who use First Coast Service Options’ (First Coast’s) Secure Provider Online Tool (SPOT) to access eligibility data through HETS. The eligibility display in SPOT now includes a tab titled QMB.

Updated MSP insurance type codes

HETS 270/271 now returns two additional Medicare Secondary Payer (MSP) insurance type codes for applicable Medicare beneficiaries. The codes that can be returned in the 2110C EBO4 element are:
AP – Auto Insurance Policy; this indicates a no-fault Medicare Set-Aside Arrangement (NFMSA)
LT – Litigation; this indicates a Liability Medicare Set-Aside Arrangement (LMSA)

HETS 271s may include QMB data

In order to help providers more readily identify the Qualified Medicare Beneficiary (QMB) status of each patient and support providers’ ability to follow QMB billing requirements, HETS 271 responses now indicate periods during which the beneficiary is enrolled in the QMB program. QMB-enrolled beneficiaries are dually eligible for both Medicare and Medicaid. Beneficiaries who are enrolled in the QMB program are not liable for Medicare co-insurance or deductible payments. Submitters should note that when the 271 2110C EB04 = QM, the DTP segment will reflect only periods of QMB enrollment within the calendar year or spell. Note that QMB status may fluctuate for a minority of beneficiaries.
If the HETS response indicates the beneficiary QMB enrollment has terminated, please verify the patient’s QMB status through state online Medicaid eligibility systems or other documentation, including Medicaid Identification cards and documents issued by the state proving the patient qualifies for the QMB program.
QMB periods are only returned in the 271 when the beneficiary has the appropriate Medicare entitlement and the QMB enrollment intersects at least one of the following:
One day within a calendar year contained in the request date(s) or unique date of earliest billing activity (DOEBA) year of any spell being returned
The DOEBA-date of latest billing activity (DOLBA) of any spell being returned
The current date
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.