US · guidance
CMS Pub. 100-16, ch. mc86c18a, § 10.2
Bill Processing
The CMS will pay on the behalf of the HCPP, through its intermediaries, all provider
costs for covered items and services furnished to the HCPP's Medicare enrollees. A
limited number of nonprovider Part B services are paid by carriers (same as cost
reimbursed HMOs/CMPs).
The HCPP agreement with CMS must provide that, in paying for services furnished to
the HCPP's enrollees, the HCPP is responsible for:
• Determining the eligibility of individuals to receive such items and services
through the HCPP;
• Making proper coverage decisions and appropriate payment for items and services
for which the HCPP's Medicare enrollees are eligible; and
• Carrying out any other procedures that CMS may require from time to time.
All health care services furnished by the HCPP may be provided through facilities
directly (facilities that are owned or related through common control) or under
arrangement. An arrangement is defined as a written agreement executed between the
HCPP and another entity in which the other entity agrees to furnish specified services to
the HCPP's Medicare enrollees. However, the HCPP retains responsibility for those
services.
History
(Rev. 30, 09-05-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7054866f055c1c392d562d4feb63dfbe46b4471eecfc361026b13886adce3844
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.