New Claims System Update

Provider Manual
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19 BENEFITS

19.2 Supplemental Benefits

Supplemental benefits are those benefits in addition to the basic Medicare services offered through Medicare Part A and B, they are not benefits offered under the federal Medicare program. Please refer to the health plan’s applicable Summary of Benefits for specific supplemental benefits being offered for each plan, as well as any limitations and requirements to utilize specific vendors for services. Providers will not be reimbursed for supplemental benefits that they are either not contracted for or that are required to be rendered by a specific vendor under the health plan. Members cannot be billed for non-covered services unless notified in advance

Supplemental benefits vary by plan, product and state. Please refer to the Summary of Benefits documents for details on which plans cover certain supplemental benefits. Providers are encouraged to call the tollfree customer service number on the back of the member ID card with any questions around services that may or may not be covered.

Not all supplemental benefits are available in all plans, and some limitations and restrictions apply. Some supplemental benefits must be rendered by the delegated vendor to be covered.