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UPREHS is Not Medicare HMO Or a Medicare Replacement Plan

UPREHS Is a Medicare SECONDARY Plan. Our Medicare members retain Original Part A and B Medicare. Members who have elected coverage through UPREHS (an HCPP) are not ‘locked-in” to receiving coverage from the Plan. (An HMO message may appear on the CMS Common Working File with the text for “Option 1” which identifies us as an HCPP group, and the message should read “Unrestricted: Carrier to process all claims.”) UPREHS holds a Section 1833 Health Care Prepayment Plan (HCPP) contract #H4652 with CMS and is authorized to make Medicare Part B payments only to participating physicians.

Facility claims for our Medicare members will be billed through the facility’s selected Medicare Intermediary. Primary DME claims are billed through the regional DMAC. Non-participating physician charges and other Part B services are billed to Palmetto, GBA.

UPREHS offers a Medicare Part D Prescription Drug Plan for our members that is administered by OptumRx.

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