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Non-Appealable Situations with Medicare Advantage Plans - Make Sure Your Staff is Aware
When a Medicare Beneficiary enrolls in a MA Plan, that MA plan takes the place of Traditional Medicare benefits. National Government Services is responsible for processing claims for fee-for-service or traditional Medicare.
When a claim is filed to NGSMedicare for a beneficiary who is enrolled in an MA plan, the claim will be denied. The Medicare RA will reflect remark code OA 109 (Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor).
These denials do not have appeal rights with traditional Medicare; therefore, the services and/or appeal shall be submitted to the MA plan, not NGSMedicare.
NGSMedicare encourages Jurisdiction 6 and Jurisdiction K providers to utilize the NGSConnex web portal or the IVR system to check beneficiary eligibility.