As a reminder, D-SNP member ID cards do not display copays or coinsurance amounts. D-SNP members have a 20% coinsurance on some services such as PCP visits (excluding annual physical), medical services related to X-rays, specialist visits, and Part B DME supplies. Any D-SNP 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: