I-Medicare Secondary Payer (MSP) yingxenye ebalulekile yokuthumela izimangalo okumelwe ziqondwe yizikhwama zezokwelapha. Imithetho ingaba yinkimbinkimbi. Amahhovisi ezempilo ebizwa ngeMillare kumele aqinisekise ukuthi abasebenzi babo abanomthwalo wokulungiselela nokuhambisa izicelo baqeqeshwe kahle futhi bahlale behambisana neziqondiso nemigomo. Cabanga ngokuya ezifundweni zemicimbi namathuba.
Kuyini i-MSP?
I-Medicare Secondary Payer noma i-MSP ikhuluma ngezinzuzo zeMedare uma uMedare engeyona umshuwalense oyinhloko. I-Medicare idinga bonke abanikezeli bezempilo ukuthi bazi ukuthi kanjani uma uM Medicare engumshwalense oyinhloko noma wesibili weziguli zabo zeMedare.
Yazi i-CWF
I-CWF noma iFund Working Working File iyisicelo sikaM Medicare esigcina ulwazi mayelana nokuhlinzekwa kwabahlomuli beMedare . Qinisekisa ukuhlola njalo i-CWF ukuze ubuyekeze ulwazi lwe-MSP ukuthola olunye ulwazi lomshwalense wezempilo.
Iziguli ze-Whom Medicare Yikhokha Okuyinhloko
I-Medicare yikhokhela oyinhloko isiguli esihlangabezana nalezi zidingo:
- 65 noma ngaphezulu futhi unehlelo lempilo yeqembu elincane ngokusebenzisa umqashi wabo wamanje noma ngomqashi wamanje womlingani wakhe
- 65 noma ngaphezulu ngomshuwalense ngokusebenzisa uhlelo lokuthatha umhlalaphansi
- Bakhubazekile futhi banehlelo lempilo yeqembu elincane ngokusebenzisa umqashi wabo wamanje noma ngomqashi wamanje womlingani wakhe
Iziguli ze-Whom Medicare yi-Payer Secondary
I-Medicare ngumkhokheli wesibili wesiguli ohlangabezana nalezi zidingo:
- 65 noma ngaphezulu futhi unesiphakamiso sempilo yeqembu elikhulu ngokusebenzisa umqashi wabo wamanje noma ngomqashi wamanje womlingani wakhe
- Ukukhutshazeka futhi kunesiphakamiso sempilo yeqembu elikhulu ngokusebenzisa umqashi wabo wamanje noma ngomqashi wamanje oshade naye
- Ihlanganiswa Ukubuyiswa Komsebenzi
- Ihlanganiswa yomshuwalense wengozi noma wemfanelo
Yini Imithi Eyenza Uma Umshwalense Oyinhloko Ulahla Ukumangalelwa?
Ezimweni lapho umshuwalense oyinhloko ephika isimangalo, uM Medicare angakhokha kuphela izizathu ezithile zokuphika, njenge:
- Inqubomgomo yombhalisi iphelile
- Inxephezelo yomsebenzi inqume ukuthi amasevisi awahlanganisiwe
- Umshuwalense wezehlakalo noma wemali uphika noma uthatha isikhathi eside ukukhokha. Umhlinzeki angase afaneleke ukukhokha okunemibandela uma isimangalo kulindeleke ukuthi uthathe isikhathi esiningi sokukhokha.
Ukusebenzisa Isimo Ikhodi FL 18-28
Ikhodi 02: Isimo sihlobene nomsebenzi
Ikhodi ye-03: Isiguli esifakwe ngumshuwalense asibonakali lapha
Ikhodi ye-05: Ubuqili bufakiwe
Ikhodi 06: Isiguli se-ESRD ezinyangeni zokuqala ezingu-30 zokufaneleka
Ikhodi 08: Umhlomulo ngeke anikeze ulwazi mayelana neminye yemishwalense
Ikhodi ye-9: Akubekezeli noma umlingani oqashiwe
Ikhodi 10: Isiguli kanye / noma umlingani oqashiwe kodwa akukhona ukufakwa kwe-EGHP
Ikhodi 11: Abahlomulayo abakhubazekile kodwa akukho ukufakwa kwe-LGHP
Ikhodi 28: I-EGHP yesineke kanye / noma yomlingani iyesibili
Ikhodi 29: Abahlomulayo abakhubazekile kanye / noma i-LGHP ilungu lomndeni lingeMediare
Ikhodi 77: Umhlinzeki wamukela noma unesibopho / okudingekayo ngenxa yesivumelwane noma umthetho wokuvumelanisa ukwamukela ukukhokhelwa ngumkhokhi oyinhloko njengokukhokha ngokugcwele. Akukho ukukhokhelwa kwemithi okuzokwenziwa.
Ukusebenzisa Amathuba Amakhodi FL 31-34
Ikhodi ye-01: Ukukhokhelwa kokukhokhelwa kwezokwelashwa kwezehlakalo
Ikhodi ye-02: Akukho mshwalense wephutha ohilelekile (sebenzisa ngekhodi ye-value 14)
Ikhodi 03: Isigameko - umthwalo (sebenzisa ngekhodi yenani 47)
Ikhodi ye-04: I-Accident - okuhlobene nomsebenzi (sebenzisa ngekhodi ye-value 15)
Ikhodi 06: isisulu sobugebengu
Ikhodi 18: Usuku lomhlalaphansi weziguli / umhlalaphansi
Ikhodi 19: Usuku lomhlalaphansi lomlingani
Ikhodi 24: Usuku lomshuwalense wenqatshelwe
Ikhodi 33: Usuku lokuqala lokubambisana kwabahlomuli be-ESRD ehlanganiswe yi-EGHP
Ikhodi A3: Umkhokheli Izinzuzo ziphelile
Ukusebenzisa Amanani Amanani FL 39-41
Faka inani lokukhokha le-Payer A elitholakala ku-FL 50 ngamakhodi 12 - 43:
Ikhodi 12: Ukusebenza umzukulu omdala noma oshade naye
Ikhodi 13: Umzuzi we-ESRD ezinyangeni ezingama-30 zokuxhumana
Ikhodi 14: Umshuwalense we-non-fault kuhlanganise ne-auto
Ikhodi 15: Inxephezelo yabasebenzi
Ikhodi 16: Insizakalo yezempilo yomphakathi noma enye i-federal agency njengesihlukumezo sobugebengu, isivivinyo sezidakamizwa, njll.
Ikhodi 41: Amaphaphu amnyama
Ikhodi 42: Ukuphathwa kwabadala
Ikhodi 43: Abazuzi abakhubazekile ngaphansi kweminyaka engu-65 ne-LGHP
Ikhodi 44: Umhlinzeki wemali avunyelwe ukwamukela kusuka kumkhokheli oyinhloko uma lesi simali singaphansi kwezindleko kodwa siphakeme kunalokho okukhokhwayo okutholiwe, ngakho-ke umkhokheli wesibili we-Medicare kufanele. Faka inani eliphelele owavumile noma unesibopho sokwamukela.
Ikhodi 47: Umshwalense wemfanelo
Ukusebenzisa Amakhodi Obudlelwane FL 59
Ikhodi 01: Oshade naye
Ikhodi 04: Ugogo / ugogo
Ikhodi 05: Umzukulu / umzukulu
Ikhodi 07: Umshana / umshana
Ikhodi 10: Ingane encane
Ikhodi 15: Iwadi
Ikhodi 17: Stepson / umzala
Ikhodi 18: Ukuzithandela
Ikhodi 19: Ingane
Ikhodi 20: Umsebenzi
Ikhodi 21: Angaziwa
Ikhodi 22: Ukuxhomeka kwabasebenzi
Ikhodi 23: Kuncike ekuxhasweni
Ikhodi 24: Ukuxhomeke kwabancinci abancane
Ikhodi 29: Okunye okubalulekile
Ikhodi 32: Umama
Ikhodi 33: Baba
Ikhodi 36: I-Emancipated encane
Ikhodi 39: Umnikeli womzimba
Ikhodi 40: Umnikezeli we-Cadaver
Ikhodi 41: Ummangali olimalile
Ikhodi 43: Ingane lapho umshwalense engekho umthwalo wemali
Ikhodi 53: Umlingani wokuphila
Ikhodi ye-G8: Okunye ubuhlobo
Vakashela i- Medicare Claims Processing ku-website ye-cms.gov ukuze uthole uhlu oluphelele lwawo wonke amakhodi wokukhokha.