Reason Code: U523A

Error Description:

The dates of service are during both a hospice election period and a MA plan's period that is in a VBID model.

Avoiding/Correcting This Error

Hospice – This reason code is a notification to the provider of a VBID patient. For more information, including calendar-year specific downloadable lists of service area plan benefit packages (PBPs) and contact information, please refer to the CMS web page, Medicare Advantage Value-Based Insurance Design Model. Claims rejected with U523A will open benefit periods in Medicare’s eligibility systems. Hospice agencies must send all notices and claims to both the participating MAO and MAC on timely basis. You must send all notices and claims to both the participating MAO and your Medicare Administrative Contractor (MAC). The MAO will process payment, and the MAC will process the claims for informational and operational purposes and for CMS to monitor the Model. If you contract to provide hospice services with the plan, be sure to confirm billing and processing steps before the calendar year begins, as they may be different.

Please Note

• While agencies are encouraged to reach out to participating MAOs about contracting opportunities, you are not required to contract. If you choose not to contract, the participating MAO must continue to pay you at least equivalent to Original Medicare rates for Medicare-covered hospice care.
• The model does not permit prior authorization requirements around hospice elections or transitions between different levels of hospice care.