Medicare_Carriers_Manual / 4255 / 4255

Why This Topic Matters

Understanding these carrier billing provisions helps organizations submit the correct plan documentation, route claims appropriately, and recognize when assignment or reimbursement procedures apply under Medicare Part B-related plan arrangements.

Article Sections

1. Ed. Note: For further information see

   A brief reference note pointing to related manual material on group practice prepayment plans.

2. 4255. Billing by Carrier-Dealing Group Practice Prepayment Plans

   Overview of carrier billing for group practice prepayment plans and the general reimbursement framework discussed in the section.

3. A. Services of Plan Physicians to Members

   Guidance on billing documentation and submission procedures for services furnished by plan physicians to plan members.

4. B. Arranged-For Services

   Discussion of services purchased from outside physicians or facilities under an arrangement and the associated carrier reimbursement process.

5. C. Services Received Outside the Plan--Not "Arranged For" by the Plan

   General handling of certain services furnished outside the plan when they are not covered by a prior arrangement.

6. D. Services to Non-Members

   Carrier reimbursement considerations for services furnished to individuals who are not plan members.

7. E. Assignment by Members

   Beneficiary assignment procedures and suggested assignment language related to plan reimbursement.