As I understand it, as part of the Affordable Care Act, CMS has established a requirement for Health Maintenance Organizations offering Medicare programs (Medicare Advantage - MA) to report the patient coinsurance, co-pay and deductible information.
This requirement is to establish a mandatory maximum out-of-pocket (MOOP) limit on overall cost-sharing for Parts A and B services.
In order to effectively gather and report this information to CMS, the Health Maintenance Organizations are requiring their contracted Independent Physician Associations to submit their professional encounter claims, which are for reporting purposes only, with the coinsurance, co-pay and deductible amounts.
In the 5010 837P transaction, the only way this data can be reported is in a secondary claim.
Billing an encounter claim as secondary is burdensome and there should be a method to report this data on a primary claim if it is now being required.