2% mandatory reduction on ALL Medicare & Medicare Advantage claims. Appears BEFORE copays/coinsurance on EOB/RA.
| Contains | Payer Type | Examples |
|---|---|---|
| ADV or MEDD | Medicare Part D | MEDDADV, MEDDAET, MEDDPRIME, PARTD |
| MPPP prefix | M3P Secondary | MPPP, MPPP7777 |
| MCAID | Medicaid | RXMCAID, MCAIDOH |
| BIN 003858 | TRICARE/ESI | 003858 |
| Payer | Medicare Advantage | Commercial | Medicaid |
|---|---|---|---|
| Aetna | 10XXXXXXXXXX | WXXXXXXXXX | All digits |
| Humana | HXXXXXXX (8 digits) | All digits | H+digits |
| BCBS | Letters+digits | Prefix+digits | Varies |
99% Rule: Patients 65+ = Medicare/MA
| MAC | Jurisdiction | States |
|---|---|---|
| NGS | L | IL, MN, WI |
| Noridian | E | AK, WA, OR, ID, MT |
| Novitas | H | AR, CO, LA, MS, NM, OK, TX |
| CGS | 15 | KY, OH |