Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 140
Requirement for PFFS Plans to Provide an Explanation of
140 - Requirement for PFFS Plans to Provide an Explanation of
Benefits to Members
(Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11)
42 CFR 422.216(d)(1)
MA organizations offering PFFS plans must provide plan members, for each claim filed
by the member or the provider that furnished the service, with an appropriate explanation
of benefits. The explanation of benefits must include a clear statement of the member's
liability for deductibles, coinsurance, copayment, and balance billing.