US · guidance
CMS Pub. 100-04, ch. 2, § 10.10
A/B MAC (A), (B), or (HHH) or DME MAC Learns Beneficiary
is an HMO Enrollee
(Rev. 3441, Issued: 01-15-16, Effective; 12-31-13; ASC X12: 01-01-12, MAC Implementation: 02-16-16; ASC X12: 02-16-16)
If the A/B MAC (A), (B), or (HHH), or DME MAC determines from its records or its
query to CMS that a patient is an HMO enrollee, the MAC will return the claim to the
provider with instructions to request payment from the HMO for payment, if appropriate.
History
(Rev. 3441, Issued: 01-15-16, Effective; 12-31-13; ASC X12: 01-01-12, MAC Implementation: 02-16-16; ASC X12: 02-16-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
57d2f54d9200d94894924c9bb9350c3c5194bb97f6491fd365622362724682c4
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