2332 lines
184 KiB
Text
2332 lines
184 KiB
Text
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Centers for Medicare & Medicaid Services
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<span class="menu-item-element" aria-current="false">Coverage</span>
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<a href="/medicare/coverage/determination-process" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169996">Coverage Determination Process</a>
|
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<a href="https://www.cms.gov/medicare-coverage-database/search.aspx" class="menu-item-element" aria-current="false">Medicare Coverage Database</a>
|
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|
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|
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|
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<a href="/files/document/medqtrlycompnlarchive072019003pdf" class="menu-item-element" aria-current="false" data-drupal-link-system-path="media/276891">Quarterly provider updates</a>
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|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<ul class="menu">
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<a href="/medicare/coding-billing/place-of-service-codes" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171996">Place of service codes</a>
|
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|
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|
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<a href="/medicare/coding-billing/icd-10-codes" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171421">ICD-10 codes</a>
|
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|
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|
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<a href="/medicare/coding-billing/healthcare-common-procedure-system" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171561">Healthcare Common Procedure Coding System (HCPCS)</a>
|
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|
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|
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<a href="/medicare/coding-billing/outpatient-code-editor" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171341">Integrated Outpatient Code Editor</a>
|
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|
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|
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<a href="/medicare/coding-billing/ncci-medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1617246">National Correct Coding Initiative (NCCI) edits</a>
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<a href="/medicare/coding-billing/provider-customer-service-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176031">Provider Customer Service Program</a>
|
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|
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|
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<a href="/medicare/coding-billing/skilled-nursing-facility-snf-consolidated-billing" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170676">Skilled Nursing Facility (SNF) consolidated billing</a>
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<a href="/roster-billing" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1612841">Roster billing</a>
|
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<a href="/medicare/coding-billing/therapy-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170641">Therapy services</a>
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<a href="/medicare/coding-billing/claims-public-health-emergencies" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620676">Medicare claims & public health emergencies</a>
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<a href="/medicare/coding-billing/guide-medical-technology-companies-other-interested-parties" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1899941">Guide for Medical Technology Companies and Other Interested Parties</a>
|
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</li>
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</div>
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<div class="subnav-wrapper--2 ds-u-display--none">
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<div class="subnav-header">
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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</div>
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<div class="menu-wrapper">
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<ul class="menu">
|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
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<a href="/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170451">Medicare Part B Drug Average Sales Price</a>
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<a href="/medicare/payment/fee-for-service-providers" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193361">All Fee-For-Service-Providers</a>
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|
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|
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|
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<a href="/medicare/payment/opioid-treatment-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1289826">Opioid Treatment Programs (OTP)</a>
|
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<a href="/covidvax-provider" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1483486">Covid-19 Vaccine Toolkit</a>
|
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<a href="/medicare/payment/bankruptcy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185906">Bankruptcy</a>
|
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|
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<li class="menu-item menu-item--l3">
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<a href="/medicare/payment/sustainable-growth-rates-conversion-factors" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169931">Sustainable Growth Rates & Conversion Factors</a>
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|
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<li class="menu-item menu-item--l2 menu-item--expanded">
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<span class="menu-item-element" aria-current="false">Medicare-Medicaid coordination</span>
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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|
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<a href="/medicare/medicaid-coordination/center-program-integrity/spotlight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/674941">Spotlight</a>
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<a href="/medicaid-chip/medicare-coordination/financial-alignment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178246">Financial alignment initiative</a>
|
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<a href="/medicare/medicaid-coordination/pace" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175651">Program of All-Inclusive Care for the Elderly (PACE)</a>
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|
||
<a href="/medicare/medicaid-coordination/plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178296">Resources for Medicare-Medicaid plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/medicaid-coordination/states" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1355341">Resources for state Medicaid agencies</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/medicaid-coordination/healthcare-fraud-prevention-partnership" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1313131">Healthcare Fraud Prevention Partnership</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/about-cms/information-systems/clinical-templates" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/189991">Clinical Templates</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Appeals & grievances</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/appeals-grievances/fee-for-service" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171221">Original Medicare appeals</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/appeals-grievances/managed-care" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169961">Managed Care appeals & grievances</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/appeals-grievances/prescription-drug" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171101">Medicare Prescription drug appeals & grievances</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/appeals-grievances/ombudsman-center" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193386">Ombudsman Center</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/appeals-grievances/appeals-decision-search-part-c-d" class="menu-item-element" aria-current="false" data-drupal-link-system-path="qic-decision-search">Appeals Decision Search (Part C & Part D)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Quality</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/value-based-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188566">Value-based programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/quality/initiatives/hospital-quality-initiative/person-family-engagement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182996">Person & Family Engagement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/quality-improvement-organizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169871">Quality improvement organizations</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/nursing-home-improvement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171236">Nursing home quality improvement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/inpatient-rehabilitation-facility" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175616">Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/home-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170541">Home Health Quality Reporting Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/end-stage-renal-disease-esrd-quality-incentive-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176126">ESRD Quality Incentive Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/meaningful-measures-initiative/cms-quality-strategy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178276">CMS National Quality Strategy</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/hospice" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175556">Hospice Quality Reporting Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/long-term-care-hospital" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175511">Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/appropriate-use-criteria-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180421">Appropriate Use Criteria Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/measures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172001">Quality measures</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/advantage-quality-improvement-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177561">Medicare Advantage quality improvement program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/physician-compare-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175221">Physician compare initiative</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169636">Quality initiatives</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/part-c-d-performance-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171491">Part C and D Performance Data</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/snf-quality-reporting-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180061"> Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health & safety standards</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/clinical-laboratory-improvement-amendments" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172651">Clinical Laboratory Improvement Amendments (CLIA)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-safety-standards/quality-safety-oversight-group-qsog" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2085911">Quality, Safety & Oversight Group (QSOG)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/quality-safety-oversight-general-information" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169631">Quality, safety & oversight general information</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-safety-standards/accreditation-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171481">Accreditation programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/quality-safety-oversight-emergency-preparedness" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172346">Emergency preparedness</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/certification-compliance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171241">Certification & compliance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169811">Enforcement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/guidance-for-laws-regulations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170071">Regulations, Certification, & Compliance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/conditions-coverage-participation" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172616">Conditions for coverage & participation</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Employers & plan sponsors</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/employers-plan-sponsors/creditable-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171701">Creditable coverage</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">IC-Placeholder-1</span>
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Audits & Compliance</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/audits-compliance/part-a-cost-report" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185256">Part A cost report audit</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/audits-compliance/part-c-d" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175921">Part C/Part D compliance & audits</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Forms & notices</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/forms-notices/cms-forms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170166">CMS forms</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/forms-notices/cms-forms-list" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174306">CMS forms list</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/forms-notices/beneficiary-notices-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170686">Beneficiary Notices Initiative (BNI)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health & drug plans</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/plan-payment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171981">Plan payment</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/plan-payment-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175081">Plan payment data</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180161">Medical loss ratio</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/coverage-gap-discount-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175906">Coverage Gap Discount Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/managed-care-marketing" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170611">Managed care marketing</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/medicare-advantage-application" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170651">Medicare Advantage application</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/medigap" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170466">Medigap (Medicare supplement health insurance)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/medical-savings-account" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172066">Medical Savings Account (MSA)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/private-fee-for-service-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170301">Private Fee-for-Service Plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/enrollment-renewal/health-plans/prepayment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170521">Health Care Prepayment Plans (HCPPs)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/enrollment-renewal/health-plans/cost" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170656">Cost plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/enrollment-renewal/special-needs-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171676">Special needs plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/network-adequacy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171301">Network adequacy</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Coordination of benefits & recovery</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177001">Overview</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting-group-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176856">Mandatory Insurer Reporting for Group Health Plans (GHP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176951">Mandatory insurer reporting (NGHP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176641">Workers' comp Medicare set aside arrangements</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/attorney-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177026">Attorney services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/beneficiary-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177036">Beneficiary services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/coba-trading-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176761">COBA Trading Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/employer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170361">Employer services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/insurer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170846">Insurer services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/prescription-drug-assistance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176791">Prescription drug assistance programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/provider-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170406">Provider services</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Settlements</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/settlements/jimmo" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193381">Jimmo Settlement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/settlements/ryan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193486">Ryan Settlement</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Medicaid/CHIP</span>
|
||
<div class="subnav-wrapper--1 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
||
<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
||
</div>
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">What is Medicaid?</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.medicaid.gov" class="menu-item-element" aria-current="false">Visit Medicaid.gov</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.medicaid.gov/about-us/beneficiary-resources/index.html#statemenu" class="menu-item-element" aria-current="false">View Medicaid maps</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="http://www.medicaid.gov/chip/index.html" class="menu-item-element" aria-current="false">Visit CHIP.gov</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Medicare-Medicaid Coordination</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicaid-chip/medicare-coordination/integrated-care-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174926">Integrated care resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicaid-chip/medicare-coordination/avoidable-hospitalizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181236">Initiative to reduce avoidable hospitalizations</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicaid-chip/medicare-coordination/financial-alignment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178246">Financial alignment initiative</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicaid-chip/medicare-coordination/integrity-institute" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1315141">Medicaid Integrity Institute</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">RG-Placeholder-1</span>
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">IC-Placeholder-2</span>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Marketplace & Private Insurance</span>
|
||
<div class="subnav-wrapper--1 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
||
<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
||
</div>
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">About the Marketplace</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/about/oversight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191061">Marketplace oversight</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/about/affordable-care-act" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191416">Affordable Care Act</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/about/overview-exchanges" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190921">Overview of the exchanges</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/about/exchange-coverage-maps" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193086">Exchange coverage maps</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/about/medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/179351">Medicare and the Marketplace</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Private Health Insurance</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/patient-bill-of-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192591">Patient’s Bill of Rights</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190956">Medical loss ratio</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/annual-limits" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191976">Annual limits</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/review-insurance-rates" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192716">Review of insurance rates</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/market-rating-reforms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191816">Market rating</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/self-funded-non-federal-governmental-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191111">Self-funded, non-federal governmental plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/grandfathered-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191456">Grandfathered plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/health-reimbursement-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193216">Health Reimbursement Arrangements</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/coverage-young-adults" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190931">Coverage for young adults</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/student-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190946">Student health plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/mental-health-parity-addiction-equity" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192601">Mental health parity and addiction equity</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/prevention" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191071">Prevention</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/consumer-protections-enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192701">Consumer protections & enforcement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/pre-existing-condition-plan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191056">Pre-existing condition insurance plan</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/glossary/qualifying-health-coverage" class="menu-item-element" aria-current="false">Qualifying Health Coverage (QHC)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">RG-Placeholder-2</span>
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">In-person assisters</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/in-person-assisters/information-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2078851">Information for Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/outreach-education" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073436">Assister outreach & education</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/applications-forms-notices" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073441">Applications, forms, & notices</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/programs-procedures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073446">Assister programs & procedures</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/technical-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073231">Assister technical resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/training-webinars" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073451">Assister training & webinars</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Agents & Brokers</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192876">Resources for Agent & Brokers</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/registration-training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1290426">Registration & training</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/open-enrollment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193226">Open enrollment</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/direct-enrollment-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1550226">Direct enrollment partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/general-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185021">General resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.youtube.com/playlist?list=PLaV7m2-zFKpgUK9AqdbnOdW69-WwodvRj" class="menu-item-element" aria-current="false">Video Learning Center</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.agentbrokerfaq.cms.gov/s/" class="menu-item-element" aria-current="false">Agent & Broker FAQ</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/files/document/agent/broker-help-desks.pdf" class="menu-item-element" aria-current="false" data-drupal-link-system-path="media/112386">Marketplace help desk & call centers</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/ffm_ab_registration_lists" class="menu-item-element" aria-current="false">Registration Completion List</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/ab-registration-tracker/" class="menu-item-element" aria-current="false">Marketplace Registration Tracker</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/ab-suspension-and-termination-list" class="menu-item-element" aria-current="false">AB Suspension & Termination List</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://localhelp.healthcare.gov/" class="menu-item-element" aria-current="false">Find local help</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/issuer-partner-lookup" class="menu-item-element" aria-current="false">Issuer and direct enrollment partner directory</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/help-on-demand" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193196">Help on demand</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/shop-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193096">SHOP Resources</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health Plans & Issuers</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/qualified-health-plan-certification" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191371">Qualified health plan certification </a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/summary-benefits-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191461">Summary of benefits & coverage</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/health-plans-issuers/insurance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192101">Insurance programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/health-plans-issuers/premium-stabilization-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191326">Premium stabilization programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/insurance-market-reforms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191421">Health insurance market reforms</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/minimum-essential-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192891">Minimum essential coverage</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace-private-insurance/health-plans-issuers/pbm-drug-pricing-review" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2088761">Drug pricing & rebate review</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Employers & sponsors</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/other-coverage" class="menu-item-element" aria-current="false">Coverage</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/shop-marketplace-overview" class="menu-item-element" aria-current="false">Regulation & guidance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/qualify-for-shop-marketplace" class="menu-item-element" aria-current="false">Small business tax credit & premium assistance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/appeal-a-shop-decision" class="menu-item-element" aria-current="false">Appeals</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/employers-sponsors/small-business-health-options-program-shop" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192901">Small Business Health Options Program (SHOP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/employers-sponsors/early-retiree-reinsurance-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191651">Early retiree reinsurance program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/employer-initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192916">Employer initiatives</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">States</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/state-marketplace-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190916">Planning & establishing a Marketplace</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/territory-cooperative-agreements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190926">Territory cooperative agreements</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/early-innovator-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191691">Early innovator program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/state-flexibility-stabilize-market" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193246">State flexibility to stabilize the Market </a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/creating-competitive-marketplace" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192231">Exchange establishment grants</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/coverage/pre-existing-conditions" class="menu-item-element" aria-current="false">Pre-existing condition insurance plan</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Resources</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/about-us" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192721">About Us</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/resources/data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191741">Data resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/letters" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191646">Letters</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/regulations-guidance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191366">Regulations & Guidance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191466">Training resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace-private-insurance/resources/marketplace-coverage-transitions" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2100621">Marketplace Coverage Transitions</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Initiatives</span>
|
||
<div class="subnav-wrapper--1 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
||
<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
||
</div>
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Burden Reduction</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/key-initiatives/burden-reduction" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2085596">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">E-health</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/key-initiatives/e-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171276">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Flu</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/key-initiativess/flu" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1399001">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health Equity</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/c2c" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1974361">Coverage to Care</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/minority-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620916">Minority health</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/c2c/es" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072591">Cobertura de atención</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/grants-awards" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1612961">Grants & awards</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Healthplan price transparency</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/key-initiatives/healthplan-price-transparency" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1567426">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Hospital price transparency</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/key-initiatives/hospital-price-transparency" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1417856">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Innovation Center</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/innovation/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2090631">Overview</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/about" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2074091">About</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/key-concepts" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072461">Key Concepts</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/innovation-center/model-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2087691">Model Data</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation-center/value-based-care-spotlight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2082926">Value-Based Care Spotlight</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/models" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072436">Innovation Models</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/innovation/where-innovation-happening" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072451">Where Innovation is Happening</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/evaluation-research-reports" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072446">Evaluations & Research Reports</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Lookup tools</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
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<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
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<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/quality/value-based-programs/quality-payment-program/lookup-tools" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/189536">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Marketplace Open Enrollment</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/quick-guide/dates-and-deadlines" class="menu-item-element" aria-current="false">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Maternal Health</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
||
|
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|
||
<li class="menu-item menu-item--l3">
|
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<a href="/maternal-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2089266">Overview</a>
|
||
</li>
|
||
</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Medicare OE partner resources</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/outreach-and-education/reach-out/find-tools-to-help-you-help-others/open-enrollment-outreach-and-media-materials" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180386">Overview</a>
|
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</li>
|
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</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Medicare Open Enrollment</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/priorities/key-initiatives/medicare-open-enrollment-partner-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180361">Overview</a>
|
||
</li>
|
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</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Nursing Home Careers</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/priorities/key-initiatives/nursing-home-careers" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2089791">Overview</a>
|
||
</li>
|
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</ul>
|
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</div>
|
||
</div>
|
||
|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span title="Open Payments landing page" class="menu-item-element" aria-current="false">Open Payments</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/priorities/key-initiatives/open-payments" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188426">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Opioids</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/priorities/key-initiatives/opioids" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620416">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Your Patient Rights</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/priorities/your-patient-rights/emergency-room-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2083831">Emergency Room Rights</a>
|
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</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medical-bill-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1912576">Medical bill rights</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Training & Education</span>
|
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<div class="subnav-wrapper--1 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
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<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
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</div>
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">CMS National Training Program</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
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|
||
<li class="menu-item menu-item--l3">
|
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<a href="https://cmsnationaltrainingprogram.cms.gov/resources" class="menu-item-element" aria-current="false">National Training Program resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://cmsnationaltrainingprogram.cms.gov/?q=global-search&combine=classroom%20modules" class="menu-item-element" aria-current="false">Class modules</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Partner outreach resources</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/partner-outreach-resources/partner-with-cms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172236">Partner with CMS</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/national-medicare-education-program-nmep" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180046">National Medicare Education Program (NMEP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/partner-outreach-resources/low-income-subsidy-lis" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171051">Low-Income Subsidy (LIS) outreach</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/assisters-navigators/enrollment/champion" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073456">Become a champion for coverage</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/faith-based" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182296">Faith-Based Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/rural-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185591">Rural Health Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/partner-outreach-resources/american-indian-alaska-native" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172176">American Indian/Alaska Native</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/center" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193436">Partnering with CMS Center</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Medicare Learning Network® (MLN)</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/medicare-learning-network/resources-training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188581">Resources & training</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/medicare-learning-network/newsletter" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181061">Newsletter</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/medicare-learning-network/compliance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181006">Compliance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/medicare-learning-network/partnerships" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177061">Partnerships</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">CMS Open Door Forums</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/open-door-forums/about" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172171">About Open Door Forums</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/ambulance" title="The Ambulance Open Door Forum (ODF) addresses issues related to the payment, billing, coverage and delivery of services in the ambulance industry." class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172296">Ambulance</a>
|
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</li>
|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/esrd" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172241">End-Stage Renal Disease (ESRD) Dialysis Facility Care Compare</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/home-health-hospice-durable-medical-equipment-dme" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/173651">Home Health, Hospice & Durable Medical Equipment (DME)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/hospitals" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172276">Hospital</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/long-term-services-supports" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172251">Long-Term Services & Supports</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/physicians-nurses-allied-health-professionals" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172306">Physicians, Nurses and Allied Health Professionals</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/rural-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172291">Rural Health</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/skilled-nursing-facilities-snf" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172316">Skilled Nursing Facilities (SNFs)/Long-Term Care</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/special" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174026">Special Open Door forums</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Look up topics</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
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|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178086">Medicare</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/medicaid" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178156">Medicaid</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/chip" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178071">CHIP</a>
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<h1 class="ds-u-visibility--screen-reader page-title"><span class="field field--name-title field--type-string field--label-visually_hidden">Medicare Dental Coverage
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<div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="rxbodyfield"><div class="ds-u-border--2 ds-u-margin-y--1 ds-u-padding--1"><strong>This content is for health care providers. If you're a person with Medicare, learn more about </strong><a href="https://www.medicare.gov/coverage/dental-services"><strong>dental services</strong></a>.</div><dl class="ckeditor-accordion"><dt><strong>What Medicare Covers</strong></dt><dd><h3><strong>Inpatient Hospital Dental Services</strong></h3><p>Under <a href="https://www.ssa.gov/OP_Home/ssact/title18/1862.htm">Section 1862(a)(12) of the Social Security Act</a> and <a href="https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411/subpart-A/section-411.15">42 CFR 411.15(i)</a>, Medicare doesn’t pay for (also called "coverage exclusion") items and services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth ("dental services"), except for inpatient hospital services connected to dental services when the patient requires hospitalization because of 1 of these: </p><ul><li>The patient’s underlying medical condition and clinical status </li><li>The severity of the dental procedure </li></ul><h3><strong>Dental Services Integral to Medicare Covered Services</strong></h3><p>The dental services coverage exclusion doesn’t apply, and Medicare can pay under Part A and Part B, when dental services are <a href="#WhatAreInextricablyLinkedDentalServices">inextricably linked</a> to the clinical success of other Medicare-covered procedures or services.</p><p>Examples of dental services that are inextricably linked to, and substantially related and integral to the clinical success of, certain Medicare-covered services could include, but aren’t limited to: </p><ul><li>Dental or oral exams as part of a comprehensive workup prior to the Medicare-covered services listed below. And, medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to or contemporaneously with these Medicare-covered services:<ul><li>Organ transplant, including hematopoietic stem cell and bone marrow transplant</li><li>Cardiac valve replacement</li><li>Valvuloplasty procedures</li><li>Chemotherapy, chimeric antigen receptor (CAR) T-cell therapy, and the administration of high-dose bone-modifying agents (antiresorptive therapy) when used to treat cancer</li></ul></li><li>Dental or oral exams as part of a comprehensive workup prior to, medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to or contemporaneously with, and medically necessary diagnostic and treatment services to address dental or oral complications after, Medicare-covered treatment of head and neck cancer using radiation, chemotherapy, surgery, or any combination of these.</li><li>Dental ridge reconstruction done as a result of and at the same time as surgery to remove a tumor.</li><li>Services to stabilize or immobilize teeth related to reducing a jaw fracture.</li><li>Dental splints, only when used as part of covered treatment of a covered medical condition such as dislocated jaw joints.</li><li>Dental or oral examination performed as part of a comprehensive workup prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of ESRD.</li><li>Medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of ESRD.</li></ul><p>Medicare payment can also be made under Part A and Part B for ancillary services and supplies incident to the covered dental services, like:</p><ul><li>Administering anesthesia</li><li>Diagnostic x-rays</li><li>Operating room use</li><li>Other related procedures</li></ul></dd><dt><strong>What Medicare Doesn’t Cover</strong></dt><dd><p>Medicare doesn’t cover items and services for the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth. Structures directly supporting the teeth are the periodontium, which includes: </p><ul><li>Gingivae</li><li>Dentogingival junction</li><li>Periodontal membrane</li><li>Cementum</li><li>Alveolar bone (alveolar process and tooth sockets)</li></ul><p>Examples of non-covered dental services include, but aren’t limited to:</p><ul><li>Routine dental care (services for the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth)</li><li>Extraction of an impacted tooth</li><li>Dental services, when performed in connection with excluded services, like to prepare the mouth for dentures, including:<ul><li>Alveoplasty (surgical improvement of the shape and condition of the alveolar process)</li><li>Dental ridge reconstruction</li><li>Frenectomy</li><li>Removing the torus palatinus (a bony growth on the roof of the mouth)</li></ul></li><li>Dental services related to other non-covered services</li></ul><table><thead><tr><th scope="col">Note:</th></tr></thead><tbody><tr><td>Under Medicare Part C, some Medicare Advantage (MA) plans may cover and pay for routine and other dental services as an added benefit. Patients can check with their MA plan to find out what dental services it covers.</td></tr></tbody></table><table><thead><tr><th scope="col"><strong>Note:</strong></th></tr></thead><tbody><tr><td>Some states may cover and pay for routine and other dental services for people dually eligible for Medicare and Medicaid. Patients can check with their <a href="https://www.medicaid.gov/about-us/contact-us/index.html">state Medicaid agency</a> to determine what dental services are covered.</td></tr></tbody></table></dd><dt><strong>What Are Inextricably Linked Dental Services?</strong></dt><dd><p>Some dental services are so integral to other medically necessary services that the clinical success of the service is dependent upon or inextricably linked to the dental services. We provide some examples above of situations where there would be an inextricable link between dental services and other Medicare-covered services.</p><p>For dental services to be inextricably linked to other Medicare-covered services, different providers (like a doctor and a dentist) must coordinate care to provide:</p><ul><li>Medicare-covered services to treat the illness</li><li>Dental services that are integral to the clinical success of the medical service</li></ul><p>Without care coordination, health care providers won’t have the information they need to decide whether a dental service is inextricably linked to a Medicare-covered service. If <span>the</span><span class="msoIns">re’s no documented evidence to support the exchange of information, or integration, between the</span><span> h</span>ealth care providers <span class="msoIns">furnishing the medical services and the dental services</span>, Medicare won’t cover and pay for dental services. Examples of care coordination may include a referral or exchange of information between a medical doctor and a dentist. </p><p>You must document coordination in the medical record. Learn more about <a href="/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/caring-for-medicare-patients-is-a-partnership.pdf" data-entity-type="media" data-entity-uuid="1da0d6b4-7973-4994-b9ed-c05782894d13" data-entity-substitution="canonical" title="MLN909340 - Collaborative Patient Care is a Provider Partnership">collaborating with other providers (PDF)</a>, including what to document. </p></dd><dt><strong>Does Medicare Pay for Multiple Dental Visits?</strong></dt><dd><p>We pay for multiple visits if it’s clinically necessary for you to provide dental services that are inextricably linked to other Medicare-covered services in more than 1 visit. For example, Medicare may pay for multiple visits for dental services to eliminate a patient’s dental infection before an organ transplant.</p></dd><dt><strong>Who Can Provide Dental Services?</strong></dt><dd><p>Medicare covers dental services provided by:</p><ul><li>Physicians, including a dentist or dental surgeon</li><li>Non-physician practitioner </li><li>Auxiliary personnel, like a dental technician, dental hygienist, dental therapist, or registered nurse, when:<ul><li>They’re directly supervised by a doctor, dentist, or other practitioner</li><li>The services meet the requirements for <a href="https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.26">incident to</a> services</li></ul></li></ul></dd><dt><strong>Where Can I Provide Dental Services?</strong></dt><dd><p><span class="msoIns">Medicare covers dental services provided in inpatient (like a hospital) and outpatient (like a dentist’s office) settings.</span></p></dd><dt><strong>Who Can Bill for Covered Dental Services?</strong></dt><dd><p>You must be a Medicare-enrolled provider to bill and get paid for providing Medicare-covered dental services. </p><p>If you’re not a Medicare-enrolled provider, you can provide services <a href="https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.26">incident to</a> services of a Medicare-enrolled physician or other practitioner. We’ll pay the Medicare-enrolled practitioner who bills for these services. These services must meet: </p><ul><li>The requirements for incident to services</li><li>The appropriate level of supervision</li><li>State law and scope of practice in the state where you provide the service</li></ul></dd><dt><strong>Who Can Enroll?</strong></dt><dd><p class="MsoNoSpacing"><span class="msoIns">To enroll in Medicare, you must be all of these:</span></p><ul><li><span class="msoIns">Doctor of Dental Surgery (DDS) or Dental Medicine (DM)</span></li><li><span class="msoIns">Legally authorized to practice dental surgery or dental medicine by the </span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.law.cornell.edu%2Fdefinitions%2Findex.php%3Fwidth%3D840%26height%3D800%26iframe%3Dtrue%26def_id%3D0d5647c5d7ec9422788fd6658511aa68%26term_occur%3D999%26term_src%3DTitle%3A42%3AChapter%3AIV%3ASubchapter%3AB%3APart%3A405%3ASubpart%3AD%3A405.400&data=05%7C01%7CPoonam.Chona%40cms.hhs.gov%7C507fa0355cd64e77071908dbce4bb7f3%7Cfbdcedc170a9414bbfa5c3063fc3395e%7C0%7C0%7C638330598390034200%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=fzDW3%2F5uv19vtK%2BzVzfRpn2AmS82RQyl1wm9hD3%2Fsro%3D&reserved=0"><span class="msoIns">State</span></a><span class="msoIns"> in which you’re providing services</span></li><li><span class="msoIns">Acting within the </span><a href="https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.law.cornell.edu%2Fdefinitions%2Findex.php%3Fwidth%3D840%26height%3D800%26iframe%3Dtrue%26def_id%3D4d7d8f4ff7841a7755ea07a4adb18743%26term_occur%3D999%26term_src%3DTitle%3A42%3AChapter%3AIV%3ASubchapter%3AB%3APart%3A405%3ASubpart%3AD%3A405.400&data=05%7C01%7CPoonam.Chona%40cms.hhs.gov%7C507fa0355cd64e77071908dbce4bb7f3%7Cfbdcedc170a9414bbfa5c3063fc3395e%7C0%7C0%7C638330598390034200%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=2DysWGHfvRx6vwRD%2FeZgEGNbfN7%2FisdSq3HIjFZZb8k%3D&reserved=0"><span class="msoIns">scope</span></a><span class="msoIns"> of your license when you provide services</span></li></ul><p><span class="msoIns">Medicare recognizes the following dental specialties for enrollment:</span></p><ul><li><span class="msoIns">Dental Anesthesiology</span></li><li><span class="msoIns">Dental Public Health</span></li><li><span class="msoIns">Endodontics</span></li><li><span class="msoIns">Oral and Maxillofacial Surgery</span></li><li><span class="msoIns">Oral and Maxillofacial Pathology</span></li><li><span class="msoIns">Oral and Maxillofacial Radiology</span></li><li><span class="msoIns">Oral Medicine</span></li><li><span class="msoIns">Orofacial Pain</span></li><li><span class="msoIns">Orthodontics and Dentofacial Orthopedics</span></li><li><span class="msoIns">Pediatric Dentistry</span></li><li><span class="msoIns">Periodontics</span></li><li><span class="msoIns">Prosthodontics</span></li></ul></dd><dt><strong>When Can I Enroll?</strong></dt><dd><p>You can enroll now.</p></dd><dt><strong>How Do I Enroll?</strong></dt><dd><h3><span class="msoIns">1. Pre-Enrollment</span></h3><ul><li><span class="msoIns">Get an </span><a href="/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/npi-what-you-need-to-know.pdf"><span class="msoIns cf01">NPI</span> (PDF)</a><span class="msoIns"> if you </span><span class="cf01 msoIns">or your organization don't already have it.</span></li><li><span class="msoIns">Become a </span><a href="https://pecos.cms.hhs.gov/pecos/PecosIAConfirm.do?transferReason=CreateLogin"><span class="msoIns">PECOS</span><span> registered user</span></a><span class="msoIns">. PECOS advantages are:</span><ul><li><span class="msoIns">Faster enrollment</span></li><li><span class="msoIns">A tailored application process where you only give information relevant to <strong>your</strong> application</span></li><li><span class="msoIns">More control over your enrollment information and reassignments</span></li><li><span class="msoIns">Easier access to check and update your information</span></li><li><span class="msoIns">Less staff time and administrative costs to complete and submit enrollment to Medicare</span></li></ul></li><li><span class="cf11 msoIns">Identify your </span><a href="/MAC-info"><span class="cf21 msoIns">Medicare Administrative Contractors (MACs)</span></a><span class="cf21 msoIns">.</span><span class="cf11 msoIns"> MACs process enrollment applications and Medicare Fee-for-Service (FFS) claims. </span><span class="msoIns">MACs also:</span><ul><li><span class="msoIns">Pay providers for Medicare FFS claims</span> </li><li><span class="msoIns">Answer providers’ questions</span></li><li><span class="msoIns">Educate providers about Medicare FFS billing requirements</span></li></ul></li></ul><h3><span class="msoIns">2. Submit Your Provider Enrollment Application(s) to Your MAC(s)</span></h3><ul><li><span class="msoIns">Choose and complete an electronic <strong>or</strong> paper application</span><ul><li><span class="msoIns">Electronic: Apply online through </span><a href="https://pecos.cms.hhs.gov/pecos/login.do"><span class="msoIns">PECOS</span></a><span class="msoIns"><u>.</u> For more information on PECOS (like technical help and FAQs), see </span><a href="/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/EnrollmentResources/provider-resources/provider-enrolment/Med-Prov-Enroll-MLN9658742.html#APPENDIX2"><span class="msoIns">Medicare Provider Enrollment</span></a><span class="msoIns">. Or, view the </span><a href="https://www.youtube.com/embed/cGjGmqb3UZQ?rel=0&autoplay=0"><span class="msoIns">PECOS Enrollment Tutorial</span></a><span class="msoIns"> video.</span><span class="msoIns"></span></li><li><span class="msoIns">Paper:</span><ul><li><span class="msoIns">Use </span><a href="/medicare/cms-forms/cms-forms/downloads/cms855b.pdf"><span class="msoIns">CMS-855B</span> (PDF)</a><span class="msoIns"> for clinics, group practices, and certain other suppliers</span></li><li><span class="msoIns">Use </span><a href="/medicare/cms-forms/cms-forms/downloads/cms855i.pdf"><span class="msoIns">CMS-855I</span> (PDF)</a><span class="msoIns"> for physicians and non-physician practitioners</span></li></ul></li></ul></li></ul><h3><span class="msoIns">3. What to Expect After Submitting Your Enrollment Application</span></h3><ul><li><span class="msoIns">MACs take approximately 45 days to review submitted applications, but it may take longer if you use the paper application.</span></li><li><span class="msoIns">Respond quickly to any requests for additional information or documents.</span></li><li><span class="msoIns">If approved, your billing effective date is the later of these:</span><ul><li><span class="msoIns">The date the MAC got your application</span></li><li><span class="msoIns">The date you begin providing services</span></li></ul></li><li><span class="msoIns">Update changes in your enrollment information in a timely manner. You must submit most changes within 30 days of the date of the change.</span></li></ul></dd><dt><strong>When Can I Start Billing?</strong></dt><dd><p class="MsoNoSpacing"><span class="msoIns">After you get the enrollment approval letter from your MAC. Your MAC will send you a copy of the letter.</span></p><p class="MsoNoSpacing"><span class="msoIns">Before you bill, you must identify your </span><a href="/medicare/coding-billing/electronic-billing"><span class="msoIns">Electronic Data Interchange (EDI)</span></a><span class="msoIns"> connectivity contractor for billing. Your MAC’s website has more information.</span></p></dd><dt><strong>How Do I Submit a Claim?</strong></dt><dd><p>You must be a Medicare-enrolled provider to submit a claim. See the “How Do I Enroll” section above.</p><p>To submit an <strong>electronic claim</strong>, use 1 of these standard formats: dental 837D, institutional 837I, or professional 837P.</p><p>To submit a <strong>paper claim</strong>, use 1 of these forms: <a href="https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/publications/cdt/2024_completioninstructions_adaclaimform_2024.pdf?rev=da5182e766e54bfb96c8c2e86261f57e&hash=EE8C7909A8C9F56FA0C1AE4FF9CB457D">dental 2024 ADA</a> (PDF), <a href="/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing-items/cms-1450" data-entity-type="node" data-entity-uuid="f398ef7f-29e7-4393-bf0c-d4fb1c022cb9" data-entity-substitution="canonical" title="CMS-1450">institutional CMS-1450</a>, or <a href="https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2024_07-v12.pdf">professional CMS-1500</a>. Mail the completed form to your Medicare Administrative Contractor (MAC).</p><p><span>To learn more:</span></p><ul><li><span>Visit your</span><a href="/MAC-info"><span> MAC's website</span></a><span> to get the dental 837D or find their mailing address</span></li><li><span>Review </span><a href="/files/document/837i-form-cms-1450-mln006926.pdf"><span>Medicare Billing: CMS-1450 & 837I (PDF)</span></a><span> for information about submitting institutional claims</span></li><li><span>Review </span><a href="/files/document/mln006976-medicare-billing-cms-1500-837p.pdf"><span>Medicare Billing: CMS-1500 & 837P (PDF)</span></a><span> for information about submitting professional claims</span></li></ul><p><span>When submitting claims:</span></p><ul><li>Use the appropriate CDT or CPT codes for the services you provide. When you submit a claim for Medicare-covered dental services, you’re certifying that the dental service is inextricably linked to a Medicare-covered medical service.</li><li>For Railroad Retirement Board patients, use the professional (837P or CMS-1500) claim form; don’t use the dental (837D or 2024 ADA) claim form.</li><li>Starting January 1, 2025, you may use the KX modifier on the dental (837D or 2024 ADA) claim form, the professional (837P or CMS-1500) claim form, or the institutional (837I or CMS-1450) claim form. We encourage you to include the KX modifier to indicate: <ul><li><span>You’ve included appropriate documentation in the medical record to support the medical necessity of the dental service or item and demonstrate the inextricable link to a Medicare-covered medical service.</span></li><li><span>The medical and dental practitioners coordinated care for the services.</span></li></ul></li><li>Starting July 1, 2025, you must use the KX modifier to identify dental services inextricably linked to covered medical services. </li><li><span>Starting July 1, 2025, you must submit an </span><a href="/medicare/coding-billing/icd-10-codes" data-entity-type="node" data-entity-uuid="d459796c-7fb4-486f-90cb-f2c140389289" data-entity-substitution="canonical" title="ICD-10"><span>ICD-10 code</span></a><span> on the dental (837D or 2024 ADA) claim form.</span></li><li>If you’re submitting a Medicare claim for a denial so you can get paid by a third-party payer (like Medicaid), <span>include the appropriate HCPCS modifiers. For example, use the GY modifier to:</span><ul><li><span>Certify</span> that you believe Medicare shouldn’t pay <span>for </span>the<span> service</span>.</li><li><span>Submit statutorily excluded services as non-covered line items on the claim with other covered dental services (like dental services inextricably linked to the clinical success of other Medicare-covered procedures or services).</span> </li></ul></li><li><table><thead><tr><th scope="col"><strong>Note:</strong></th></tr></thead><tbody><tr><td><span>For Medicare claim denials, the dental (837D or 2024 ADA) claim form accepts the GY modifier. On the professional (837P or CMS-1500) claim form</span>, you can still use the GA, GY, and GZ modifiers for Medicare claim denials. <a href="/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/abn_booklet_icn006266.pdf">Learn more about when to use these modifiers (PDF)</a>.</td></tr></tbody></table></li><li><span>Don’t simultaneously submit the same claim to multiple primary payers. </span><ul><li><span>If Medicare pays the claim and there are costs Medicare didn’t cover (like a deductible or coinsurance), you can bill other secondary insurance for the unpaid amounts.</span></li><li><span>If Medicare denies the claim, you may be able to submit the claim to another primary payer (like Medicaid).</span></li></ul></li><li><span>Don’t send attachments, like x-rays or periodontal charting, with your claim. Your MAC will contact you in writing if they need additional information.</span></li></ul></dd><dt><span><strong>What Does Medicare Pay for Covered Dental Services?</strong></span></dt><dd><p><span>Medicare payment rates for covered dental services vary based on where you provide the services. You must be a Medicare-enrolled provider to bill and get paid for providing Medicare-covered dental services. </span></p><p><span><strong>Inpatient setting</strong></span></p><p><span>For covered dental services performed in a<strong> </strong></span><a class="ck-anchor" id="_Hlk156452641"><span><strong>Hospital Outpatient Department </strong></span></a><span><strong>(HOPD) or </strong></span><a class="ck-anchor" id="_Hlk156453174"><span><strong>Ambulatory Surgery Center </strong></span></a><span><strong>(ASC)</strong>, Medicare pays for both:</span></p><ul><li><span>The facility fee component of the service in the amount listed in the </span><a href="/medicare/payment/prospective-payment-systems/hospital-outpatient/addendum-a-b-updates"><span>OPPS</span></a><span>/</span><a href="/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-payment-rates-addenda"><span>ASC</span></a><span> addenda </span></li><li><span>The professional fee/service to the practitioner under the </span><a href="/medicare/payment/fee-schedules/physician"><span>Physician Fee Schedule</span></a><span> (PFS)</span></li></ul><p><span>Medicare updates the HOPD and the ASC payment rates annually. </span></p><p><span>For covered dental services performed in an <strong>HOPD</strong>, visit</span><a class="ck-anchor" id="_Hlk156452665"><span> </span></a><a href="/medicare/payment/prospective-payment-systems/hospital-outpatient/addendum-a-b-updates"><span>OPPS Addendum A and Addendum B Updates</span></a><span>, and find the latest </span><a class="ck-anchor" id="_Hlk156452685"><span>Addendum B</span></a><span> for OPPS payment rates (which includes payment rates for individual CDT and CPT codes). </span></p><p><span>For covered dental services performed in an <strong>ASC</strong>, Medicare only pays for surgical services that are:</span></p><ul><li><span>Included on the ASC Covered Procedures List (CPL) </span></li><li><span>Covered ancillary services integral to services on the ASC CPL</span></li></ul><p><span>Visit</span><a class="ck-anchor" id="_Hlk156453333"><span> </span></a><a href="/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-payment-rates-addenda"><span>ASC Payment Rates – Addenda</span></a><span> for the latest:</span></p><ul><li><span>ASC CPL </span></li><li><span>List of ASC-covered ancillary services integral to covered surgical services and their payment rates </span></li></ul><p><span><strong>Outpatient setting</strong></span></p><p><span>For covered dental services performed in <strong>the dentist’s office</strong>, Medicare pays for the professional fee/service to the practitioner under the PFS. The </span><a href="/MAC-INFO"><span>MAC</span></a><span> sets the payment rates for dental services paid under the PFS.</span></p></dd><dt><strong>Additional Resources</strong></dt><dd><ul><li><a href="/files/document/r11995bp.pdf" data-entity-type="media" data-entity-uuid="c79057b8-0790-4c6f-840d-94897af89cf8" data-entity-substitution="canonical" title="R11995BP">CR 13181 (PDF)</a></li><li><a href="/files/document/r12047bp.pdf" data-entity-type="media" data-entity-uuid="18b0d2aa-c962-4800-a714-b62db1db2c0e" data-entity-substitution="canonical" title="R12047BP">CR 13190 (PDF)</a></li><li><a href="/files/document/r12933otn.pdf">CR 13649 (PDF)</a></li><li><a href="/medicare/medicare-fee-service-payment/physicianfeesched/pfs-federal-regulation-notices/cms-1770-f" data-entity-type="node" data-entity-uuid="14fc3d14-d9c4-491e-83cf-7e421711ecf8" data-entity-substitution="canonical" title="CMS-1770-F">CY 2023 Physician Fee Schedule Final rule</a></li><li><a href="/medicare/medicare-fee-service-payment/physicianfeesched/pfs-federal-regulation-notices/cms-1784-f" data-entity-type="node" data-entity-uuid="d6d80c39-1e86-4451-889e-451145b6ff04" data-entity-substitution="canonical" title="CMS-1784-F">CY 2024 Physician Fee Schedule Final rule</a></li><li><a href="https://www.govinfo.gov/content/pkg/FR-2024-12-09/pdf/2024-25382.pdf">CY 2025 Physician Fee Schedule Final rule</a></li><li><a href="/medicare-coverage-database/view/article.aspx?articleid=59543&ver=4&bc=0">LCD A59543 Billing & Coding: Dental Services</a></li><li><a href="/medicare-coverage-database/view/article.aspx?articleid=59447&ver=4&bc=0">LCD A59447 Billing & Coding: Dental Services</a></li><li><a href="/medicare-coverage-database/view/article.aspx?articleid=59450&ver=4&bc=0">LCD A59450 Billing & Coding: Dental Services</a></li><li><a href="/medicare-coverage-database/view/article.aspx?articleid=59449&ver=2&bc=0">LCD A59449 Billing & Coding: Dental Services</a></li><li><a href="https://www.medicaid.gov/medicaid/benefits/dental-care/index.html">Medicaid Dental Benefits</a></li><li><a href="/medicare/payment/fee-schedules/physician" data-entity-type="node" data-entity-uuid="5e90673b-5f86-44cf-8efb-81d9e85152bb" data-entity-substitution="canonical" title="Physician Fee Schedule">Physician Fee Schedule</a></li></ul></dd></dl><p> </p></div></div>
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