Tip: Medicare Advantage Plans
- Kenley Money
- Kathleen Hart (Unlicensed)
Number | 0048 |
|---|---|
Submitting Entities | ALL |
Add Date | Mar 11, 2020 |
Update Date | Jul 14, 2022 May 25, 2023 Mar 13, 2024 Dec 20, 2024 |
Update | Updated instructions to identify Medicare Advantage Plans in MCR and commercial claims included in the January 2025 data tips email |
Description | Identifying Medicare Advantage Plans in Medicare FFS data and Commercial claims |
Action / Resolution | Commercial Claims Medicare Advantage plans managed by commercial submitting entities can be selected when ME001_CAT in ('MCR_ADV', ‘MCRAdvPhm’). Payer Type definitions can be found here: Redefined field - ME001_CAT (PAYER_TYPE) Medicare Fee For Service Data Medicare Advantage plans do not always have plan names that can easily be identified as Medicare Advantage. These plans can be identified when Insurance Product Type Code (ME003, MC003, PC003) contains the values (MDV','HN','HS','MCR','MA','MB','MH', ‘MHO','MI','MPO' or ME001, MC001, or PC001 in ('10155',’60054M') Alternately, if the data requester has access to Medicare Fee for Service data (available to state agencies only), Medicare Advantage plans are identified in the following way:
[HMO_IND_01] = '0' beneficiary enrolled in Fee for service plan in January of the enrollment year
[HMO_IND_02] = '0' beneficiary enrolled in Fee for service plan in February of the enrollment year
[HMO_IND_03] = '0' beneficiary enrolled in Fee for service plan in March of the enrollment year
[HMO_IND_04] = '0' beneficiary enrolled in Fee for service plan in April of the enrollment year
[HMO_IND_05] = '0' beneficiary enrolled in Fee for service plan in May of the enrollment year
[HMO_IND_06] = '0' beneficiary enrolled in Fee for service plan in June of the enrollment year
[HMO_IND_07] = '0' beneficiary enrolled in Fee for service plan in July of the enrollment year
[HMO_IND_08] = '0' beneficiary enrolled in Fee for service plan in August of the enrollment year
[HMO_IND_09] = '0' beneficiary enrolled in Fee for service plan in September of the enrollment year
[HMO_IND_10] = '0' beneficiary enrolled in Fee for service plan in October of the enrollment year
[HMO_IND_11] = '0' beneficiary enrolled in Fee for service plan in November of the enrollment year
[HMO_IND_12] = '0' beneficiary enrolled in Fee for service plan in December of the enrollment year
[HMO_IND_01] = 'C' beneficiary enrolled in Medicare Advantage plan in January of the enrollment year
[HMO_IND_02] = 'C' beneficiary enrolled in Medicare Advantage plan in February of the enrollment year
[HMO_IND_03] = 'C' beneficiary enrolled in Medicare Advantage plan in March of the enrollment year
[HMO_IND_04] = 'C' beneficiary enrolled in Medicare Advantage plan in April of the enrollment year
[HMO_IND_05] = 'C' beneficiary enrolled in Medicare Advantage plan in May of the enrollment year
[HMO_IND_06] = 'C' beneficiary enrolled in Medicare Advantage plan in June of the enrollment year
[HMO_IND_07] = 'C' beneficiary enrolled in Medicare Advantage plan in July of the enrollment year
[HMO_IND_08] = 'C' beneficiary enrolled in Medicare Advantage plan in August of the enrollment year
[HMO_IND_09] = 'C' beneficiary enrolled in Medicare Advantage plan in September of the enrollment year
[HMO_IND_10] = 'C' beneficiary enrolled in Medicare Advantage plan in October of the enrollment year
[HMO_IND_11] = 'C' beneficiary enrolled in Medicare Advantage plan in November of the enrollment year
[HMO_IND_12] = 'C' beneficiary enrolled in Medicare Advantage plan in December of the enrollment year |
Category 1 | Medicare Advantage |
Category 2 | Medicare |
Tip / Issue | Tip |