decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2000 / AB-00-45
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Article Overview
This May 2000 HCFA Program Memorandum explains the award of a Medicare+Choice private fee-for-service contract to Sterling Life Insurance Company and summarizes how the plan operates for beneficiaries, providers, and intermediaries. It is relevant to Medicare managed care administration, claims handling, plan payment arrangements, and the general framework for private fee-for-service access and contracting under Medicare+Choice. The article also notes the affected service areas, effective date, and where inquiries should be directed.
Why This Topic Matters
It helps readers understand a Medicare+Choice private fee-for-service arrangement, including who the memo applies to, what administrative workflow changes are involved, and how plan-level payment and access concepts are framed for Medicare operations.
Article Sections
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Program Memorandum and Subject
Introductory memorandum details identifying the transmittal, issuing agencies, date, and the general topic of the notice.
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Award of Medicare+Choice Private Fee-for-Service Contract
Summarizes the contract award, effective date, plan name, and the general Medicare+Choice and private fee-for-service context.
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Service Areas and Inquiries
Identifies the states and rural counties associated with enrollment availability and addresses how inquiries are to be handled during rollout.
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The M+C Private Fee-for-Service Option
Provides a broad overview of how private fee-for-service plans function within Medicare+Choice, including enrollment, claims flow, and beneficiary access concepts.
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Plan Payment and Access
Discusses general payment methodology concepts and the plan’s approach to demonstrating access to covered services under Medicare+Choice requirements.
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Deemed Contracting
Addresses the general concept of deemed contracting for providers and suppliers and the role of the plan in resolving related questions.
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Effective Date and Administrative Instructions
Lists the effective and implementation dates, budgetary note, retention guidance, and contact information.
What You Will Learn
- The purpose of the memorandum and its Medicare+Choice context
- How a private fee-for-service plan is described at a high level
- Which geographic service areas are associated with the plan
- How beneficiary enrollment and claims routing are described
- What general payment and access topics are addressed
- How the memorandum discusses provider and supplier contracting status
- Administrative timing and implementation information for the notice
Who Should Read This
- Medicare intermediaries
- Medicare carriers
- Provider and supplier billing staff
- Medicare managed care administrators
- Compliance and reimbursement professionals
Codes Discussed
Code Ranges Discussed
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