myCGS

Eligibility

Plan Coverage

The "Plan Coverage" sub-tab provides information regarding the beneficiary's enrollment under Medicare Advantage (MA) Managed Care Plans (commonly referred to as Part C contracts) that provide Part A and B benefits for beneficiaries.

This sub-tab also provides information on a beneficiary's Part D prescription drug coverage.

NOTE: Whenever myCGS indicates that a beneficiary has coverage through a non-Medicare entity (MA or Medicare Drug Benefit plans), the inquiring provider should always contact the non-Medicare entity for complete beneficiary entitlement information.

Screenshot

The table below describes the "Plan Coverage" sub-tab fields:

Field Name Description

Plan Type

A full plan description followed by Plan Type Code:

  • Health Maintenance Organization Medicare Non Risk – HM
  • Health Maintenance Organization Medicare Risk – HN
  • Indemnity – IN
  • Preferred Provider Organization – PR
  • Point of Service – PS
  • Pharmacy – Part D

Enrollment Date

The date that indicates the start of enrollment to the coverage plan

Disenrollment Date

The date that indicates the termination of enrollment to the coverage. No date in this field means the plan enrollment has not terminated.

Contract Name

A descriptive name of the beneficiary's insurance coverage organization

Contract Number

The contract number (if on file)

Address

The coverage plan's address line 1

Phone Number

The coverage plan's contract telephone number (if on file)

Address 2

The coverage plan's address line 2

City

The coverage plan's city

State

The coverage plan's state

ZIP Code

The coverage plan's ZIP code

Website

The coverage plan's website address that will provide information on the beneficiary's insurance

Bill Code

The bill code of the plan type. This field only applies to plan types HM, HN, IN, PR, and PS.

Medicare Beneficiary "locked in" to MCO
A - Fiscal Intermediary should process all claims
B - MCO should process only in-plan Part A claims and in-area Part B claims
C - MCO should process all claims

Medicare Beneficiary NOT "locked in" to MCO
1 - Fiscal Intermediary should process all claims
2 - MCO should process only in-plan Part A claims and in-area Part B claims

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