US · guidance
CMS Pub. 100-16, ch. mc86c17b, § 300.2
The Medicare HMO/CMPs’ Obligations
When the Medicare program is not the primary payer for covered Medicare services
provided to Medicare members of an HMO/CMP, the organization must:
• Identify payers that are primary to Medicare under §1862(b) of the Act;
• Determine the amounts payable by these payers; and
• Take steps in accordance with these instructions and the instructions in
§§3407-3419 and §§3489-3492 of the Medicare Intermediary Manual to assure
that Medicare pays only secondary benefits when another insurer is primary
payer.
In addition, in situations when the cost-based HMO/CMP may charge another
HMO/CMP or the Medicare beneficiary for services when Medicare is not primary payer,
it may also require the enrollee to sign a subrogation agreement under which the
HMO/CMP is given the rights the beneficiary has against the third party.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
de2e997950173496ff3bbd5f9699c9e143754d28faa629b40e7b66ff4ef9fd33
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