non assigned

What is a non assigned claim?

Under Medicare Part B, physicians and suppliers submit both assigned and non-assigned claims for these services and items. For assigned claims, physicians and suppliers agree to accept the amount allowed by Medicare as full payment. Medicare pays 80 percent of this amount directly to the physician or supplier and the beneficiary pays 20 percent (plus any outstanding deductible). In non-assigned claims, the physician or supplier bills the beneficiary for the total charge for the service or item provided, which can exceed the amount allowed by Medicare. Medicare pays the beneficiary 80 percent of the allowed amount; the beneficiary pays all remaining charges.

Only a nonparticipating Medicare physician may file non assigned. A nonparticipating physician does not agree to accept Medicare’ s allowed amount as payment in full and may charge the beneficiary, up to the limiting charge, for the service(s).

Check the block 27 in CMS 1500 to indicate whether the provider of service or supplier accepts assignment of Medicare benefits.

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