Resolution of Issue with Part C claims for Q class recipients

There has been an issue with Part C claims for Q class recipients in which the cost share was inappropriately cut back or denied. Several types of claims may have been affected, including rental versus purchase price for durable medical equipment, endoscopy claims that allow one line to pay at the base rate and the remainder of lines are cutback 50 percent, or some dental procedures where a combination of codes are limited to the amount of the base code.

This issue was resolved on April 19. If providers have a Medicare primary claim for a Q class recipient that had cost share cut back or denied, they can resubmit denied charges or replace claims that paid incorrectly.