Notice to Beneficiary

40.1.3 - Notice to Beneficiary (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) The A/B MACs and DME MACs deny any bills received for Medicare payment from, or on behalf of a beneficiary enrolled in a managed care GHP who has previously been notified in writing. Advise that the reason for the denial is that Medicare’s records show that the beneficiary is a member of a managed care health plan as follows: Our records show that you are a member of an employer- sponsored managed care health plan. Because Medicare is secondary payer for you, services from sources outside your health plan that could have been obtained from or through the managed care health plan are not payable. Medicare’s records show that you were previously informed of this rule. Therefore, payment cannot be made for the non-plan services you received. (There are standard Medicare Summary Messages (MSN) that convey this information.)