Update on explanations of payments for 2020 Medicare dates of service


Our 2020 explanation of payments (EOP) for Medicare claims with 2020 dates of services will no longer itemize the 2 percent provider payment reduction fee, known as “Medicare sequestration.” The reduction will be automatically made from the provider payment after copayments and/or coinsurance are applied. The claim line on the EOP will include a note with the letter “S” to indicate the payment was subject to Medicare sequestration.

For example:

  1. A provider may receive an EOP that has a claim item with the letter “S” in the notes and shows $100 allowable charge that was reduced by a $20 copayment.
  2. The EOP will show that the provider is owed $80 for the services.
  3. The claim, however, was subject to Medicare sequestration. So ConnectiCare’s payment will only reflect $78.40. A 2 percent reduction was applied to the $80 provider payment listed on the EOP.

Providers will need to manually determine the sequestration fee by simply subtracting 2 percent from provider payment flagged with the “S” note. So if a provider sees an $80 payment flagged with the note for Medicare sequestration, the calculated payment will be $78.40.

This applies to our EOPs generated for Medicare Advantage claims with dates of service on and after Jan. 1 ,2020. EOPs for our Medicare Advantage claims with 2019 dates of services still itemize the Medicare sequestration fee.