While Social Security and Railroad Medicare cards are red, white, and blue in color, there are a few differences that we want you to know about. The front of your Medicare card shows Medicare Health Insurance provided by the Railroad Retirement Board, instead of a Social Security Medicare card showing their toll-free phone number. Your card also displays your Medicare Claim Number with the alpha-prefix (1-3 letters) in front of your number, instead of the Social Security Medicare Claim Number, which ends with a letter. The last detail shown on the back of your Medicare card is the Railroad Retirement Board Home Office address to return a lost card.
Full Answer
How do I file Part B claims to railroad Medicare?
How Do I File Part B Claims to Railroad Medicare? Before filing claims electronically to Railroad Medicare, you must have an EDI enrollment packet on file with Palmetto GBA. See our Electronic Data Interchange (EDI) resources for more information on enrolling for electronic claim submissions.
What is the deadline for filing a railroad Medicare claim electronically?
If you are required to submit electronically to your local Medicare Administrative Contractor (MAC), CMS requires you to submit electronically to Railroad Medicare, regardless of how many Railroad Medicare patients you may serve. Claims must be filed to the appropriate MAC no later than 12 months, one calendar year, from the date of service.
What is a railroad Medicare provider transaction access number (ptan)?
If you are a Medicare-enrolled provider, you are eligible to render services for a Railroad Medicare beneficiary, but you must be assigned a Railroad Medicare Provider Transaction Access Number (PTAN) before Railroad Medicare can process your claims.
What does the railroad Medicare customer service center do?
Beneficiary Customer Service Center Assistance for people with Railroad Medicare. Benefit Integrity Responsible for deterring and detecting fraud, waste and abuse in the Railroad Medicare program. Claims Assistance with filing claims.
How do I bill railroad Medicare claims?
Getting Started With Railroad Medicare BillingStep 1: Ensure your enrollment information is correct with your local Part B Medicare Administrative Contractor (MAC) ... Step 2: Request a Railroad Medicare PTAN. ... Step 3: Receive your Railroad Medicare PTAN. ... Step 4: File Electronically. ... Step 5: Go Green — Electronic Remits.
Is railroad Medicare the same as Medicare?
A: The only difference is that retired railroad beneficiaries have their Part B benefits administered by the Palmetto GBA Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) regardless of where they live. Members should be certain to advise providers of this when they receive treatment.
What is railroad Medicare payer?
Payer Name: Medicare - Railroad|Payer ID: MR018|Professional (CMS 1500)
Can Medicare railroad be secondary?
The online calculator is designed to provide an estimate only. A Medicare secondary payer (MSP) overpayment can occur when Medicare has processed and paid a claim as the primary payer, but should have paid as secondary.
Is railroad Medicare a Medicare Advantage Plan?
Yes, Railroad Medicare beneficiaries can choose to enroll in Medicare Advantage plans.
What do railroad Medicare ID numbers look like?
It will contain capital letters (all letters with the exception of S, L, O, I, B and Z) and numbers (0-9). The 2nd, 5th, 8th, and 9th characters will always be a letter, while characters 1, 4, 7, 10, and 11 will always be a number. The 3rd and 6th characters will be a letter or a number.
Where do I file a railroad Medicare claim?
You can either file electronic claims to Railroad Medicare through a clearinghouse or other third-party claims submitter, or you can submit paperless claims directly through Palmetto GBA's online provider portal eServices eClaims option.
What is the EDI number for railroad Medicare?
If you are a Railroad Medicare submitter and have a question about your status, please call 888-355-9165. If you are a Part A or Part B Palmetto GBA submitter and have a question about your status, please call 855-696-0705.
How do I find Railroad Medicare?
The Medicare card of a person with Railroad Medicare is unique, as seen below, with the RRB logo in the upper left corner and “Railroad Retirement Board” at the bottom.
Can you collect both railroad retirement and social security?
6. Another unique characteristic of RRB 's benefit structure is that to receive benefits under the Railroad Retirement Act an individual must cease all employment in RRB -covered positions. 7. Some workers are eligible for both Social Security and RRB benefits.
Who are the primary recipients of Medicare?
Medicare is the federal health insurance program for:People who are 65 or older.Certain younger people with disabilities.People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
Can a spouse collect railroad retirement and social security?
Yes. The tier I portion of a spouse annuity is reduced for any social security entitlement, regardless of whether the social security benefit is based on the spouse's own earnings, the employee's earnings or the earnings of another person.
Time Limit for Filing Part B Claims
Claims must be filed to the appropriate MAC no later than 12 months, one calendar year, from the date of service. Timely filing is determined by the date a processable claim is received by the appropriate MAC. Claims that are rejected as unprocessable are not considered submitted claims for the purposes of determining timely filing.
Where do I file Part A, DMEPOS and Home Health and Hospice claims for Railroad Medicare beneficiaries?
Part A — The jurisdictional A/B Medicare Administrative Contractors (A/B MACs) process hospital facility claims and skilled nursing facility claims for both Medicare and Railroad Medicare beneficiaries. You can use the CMS MAC Website List to find your local A/B MAC.
What is the CMS 1500 form?
The CMS-1500 claim form answers the needs of many insurers. It is the basic form prescribed by the Centers of Medicare & Medicaid Services (CMS) for the Medicare program for claims from physicians and suppliers. The revised version of the CMS 1500 claim form is version and is approved under the OMB control number 0938-1197.
Do you list other supplemental coverage in item 9?
Do not list other supplemental coverage in Item 9 and its subdivisions at the time a Medicare claim is filed. Other supplemental claims are forwarded automatically to the private insurer if the private insurer contracts with the carrier to send Medicare claim information electronically.
Can you submit paper claims electronically?
Even if you qualify to submit paper claims, consider submitting electronically.
Where is the railroad retirement board on my Medicare card?
Your Medicare card is similar to the new Medicare cards that all beneficiaries receive, with the exception that “Railroad Retirement Board” is printed in a red banner at the bottom of the card .
What happens if you receive a railroad retirement?
If you receive Railroad Retirement benefits or disability annuity benefits from the railroad at the time of eligibility for Medicare, you are automatically enrolled in Medicare Parts A and B by the RRB. After the RRB automatically enrolls you, you receive your Medicare card together with a letter from the RRB explaining ...
What is the RRB?
The RRB administers insurance and retirement benefits to all railroad workers in the country. Instead of getting retirement benefits from the U.S. Social Security Administration as other workers do, the RRB provides railroad workers and their families with retirement benefits, along with unemployment and sickness benefits, ...
Do you have to go through the Social Security Administration if you are employed by the railroad?
However, if you have end-stage renal disease (ESRD) and qualify for Medicare, you must go through the Social Security Administration even if you are employed by the railroad.
Does Medicare cover railroad employees?
Medicare offers coverage to railroad employees just as it does for people who have Social Security. The payroll taxes of railroad employees include railroad retirement and Medicare hospital insurance taxes.
When can I disenroll from Medicare Advantage?
A: You can generally disenroll from a Medicare Advantage plan only during the Medicare open enrollment period of October 15-December 7, the Medicare Advantage Plan disenrollment period of January 1-February 14, or when you qualify for a Special Enrollment Period (SEP). For more information on SEPs, go to www.Medicare.gov.
What is the difference between Medicare Part B and Medicare Part B?
A: The only difference is that retired railroad beneficiaries have their Part B benefits administered by the Palmetto GBA Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) regardless of where they live. Members should be certain to advise providers of this when they receive treatment. Also, be sure to provide your Railroad Medicare card at time of service as the information on the card identifies you as a Railroad Medicare beneficiary to the provider.
Does Medicare cover injectable cancer drugs?
A: Only in limited instances will Medicare Part B provide for prescription drug coverage, such as for certain injectable cancer drugs or immunosuppressive drugs. All other Medicare benefits for prescription drugs require enrollment in a Part D Prescription Drug Program.
Do I need to sign up for Medicare Part B?
A: As an active employee covered under the active employee H&W Plan, you do not need to sign up for Medicare Part B. You should, however, sign up for Medicare Part A (for which there is no cost) to avoid any future Medicare enrollment problems. It is strongly recommended that you contact the Railroad Retirement Board three (3) months before you turn age 65 to start the Medicare enrollment process.
Can Medicare cards be similar?
A: This can easily happen as the two Medicare cards are very similar. The doctor’s office should pay close attention to the specific details printed on your Railroad Medicare card.
Does Medicare pay for hearing aids?
A: No, Medicare does not pay for hearing aids or hearing exams, when the purpose of the exam is to determine whether you need hearing aids or for fitting hearing aids.
What to do if there is no Medicare primary?
If there is no insurance primary to Medicare, enter the word “none”. If there has been a change in the insured’s insurance status, e.g., retired, enter the word “none” and proceed to item 11b. Item 11a-Insured's date of birth: Enter the insured’s eight-digit birth date (MM/DD/CCYY) and sex if different from Item 3.
What are the items that Medicare may be secondary to?
If there is insurance primary to Medicare, enter the insured’s policy or group number and then proceed to Items 11a–11c. Items 4, 6, and 7 must also be completed. Circumstances under which Medicare may be secondary to another insurer, includes: Group health plan coverage. Working aged;
What is EOB in Medicare?
If the primary payer’s explanation of benefits (EOB) does not contain the claims processing address, record the claims processing address directly on the EOB. Completion of this item is conditional for insurance information primary to Medicare.
What does "yes" mean on Medicare?
Any item checked "yes" indicates there may be other insurance primary to Medicare. Identify primary insurance information in item 11. Completion of items 10a-c is required for all claims; "yes" or "no" must be indicated.
What is the word "none" in Medicare?
If there is no insurance primary to Medicare, the word "none" should be entered in block 11. Completion of item 11 (i.e., insured's policy/group number or " none ") is required on all claims. Claims without this information will be rejected.
When submitting paper or electronic claims, what is item 11?
When submitting paper or electronic claims, item 11 must be completed. By completing this information, the physician / supplier acknowledges having made a good faith effort to determine whether Medicare is the primary or secondary payer. Claims without this information will be rejected.
Does Medicare cover claims submitted on paper?
Reminder: Medicare will not cover claims submitted on paper that do not meet the limited exception criteria. Claims denied for this reason will contain a claim adjustment reason code and remark code indicating that the claim will not be considered unless submitted via an electronic claim.
Provider Contact Center: 1-888-355-9165
Call the Provider Contact Center (PCC) to speak with representatives in Customer Service, Provider Enrollment, Electronic Data Interchange, eServices and Telephone Reopenings.
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Use the IVR to request routine claim status, beneficiary eligibility, and payment information and to request a duplicate remittance advice.
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Feedback to the Railroad Retirement Board (RRB)
If you would like to send any feedback to the RRB regarding your experience with Palmetto GBA, please direct your comments to: RRBMedicarecommunications@rrb.gov .
Tuesday, September 29, 2015
The Palmetto GBA Denial Resolution tool includes resources for resolving the top claim rejections and denial reasons. Save time and resources by looking here before you pick up the phone.
Railroad Medicare Denials: Top Reasons and Procedures
The Palmetto GBA Denial Resolution tool includes resources for resolving the top claim rejections and denial reasons. Save time and resources by looking here before you pick up the phone.