Medicare program created in 1997 and also referred to as Medicare Part C , which was replaced in 2006 by the Medicare Advantage (MA) program. See Medicare Part C .

Public or private entity organized and licensed by a state as a risk-bearing entity (with the exception of a provider-sponsored organization receiving waivers) that is certified by the Centers for Medicare and Medicaid Services (CMS) as meeting the M+C contract requirements. Also referred to as Medicare Part C , which was replaced in 2006 by the Medicare Advantage (MA) program. See Medicare Part C .

Type of Medicare Advantage Plan in which the member uses doctors, hospitals, and providers that belong to the network but can also use physicians, hospitals, and providers outside of the network for an additional cost.

Contractor that handles all Medicare direct-billing payments for direct-billed beneficiaries. MPCC is located in Pittsburgh, Pennsylvania.

Federal legislation enacted in 2003 that amended Title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare program, to modernize the Medicare program, to amend the Internal Revenue Code of 1986 to allow a deduction to individuals for amounts contributed to health savings security accounts and health savings accounts, to provide for the disposition of unused health benefits in cafeteria plans and flexible spending arrangements, and for other purposes.

Type of Medicare Advantage Plan in which the member may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare program, decides how much it will pay and what the patient pays for the services. The patient may pay more or less for Medicare-covered benefits. The patient may have extra benefits the Original Medicare Plan does not cover.

Written guidelines that reflect the principles, values, and priorities for the Medicare Integrity Program. The primary principle of program integrity is to pay claims correctly.

National administrative code set used in the X12 835 claim payment and remittance advice transaction. It provides either claim-level or service-level Medicare-related messages that cannot be communicated with a claim adjustment reason code.