As a reminder, DSNP member ID cards do not display copays or coinsurance. DSNP members can have cost sharing apply to their coinsurance or deductible on some services such as PCP visits (excluding annual physical), medical services related to X-rays, specialist visits, and Part B DME supplies. Any DSNP copay or coinsurance should be billed to Medicaid. If you are not an approved Medicaid provider and are unable to submit your claim to Medicaid, you are not allowed to bill the member for the copay/coinsurance.

Denial reason code according to your provider remittance advice: 

For more information related to cost sharing please view our Q&A and Scenarios references: 

• Medicare Cost Sharing by Medicaid Q&A
• Medicare Cost Sharing by Medicaid Scenarios
• BlueRI for Duals (HMO-DSNP) Quality Improvement Process