Medicare Advantage Plans

Medicare Advantage Plans

Medicare Advantage (MA) plans must include the OTP benefit as of January 1, 2020 and contract with OTP providers in their service area, or agree to pay an OTP on a non-contract basis. In covering the OTP benefit, MA plans must use only Medicare-enrolled OTP providers. 

MA Plans & OTP Payment
Regardless of whether an OTP is under contract with an MA plan or rendering services on a non-contract basis, the OTP must contact each specific plan with payment questions. MA plans pay OTPs on a non-contract basis at the Original Medicare payment rate.

Contacting MA Plans
OTPs should contact MA plans and ask for “provider services” to help with questions about payment for OTP services under that MA plan. 

If you’re not sure if your Medicare patient is enrolled in an MA plan:

  • Ask for the patient’s insurance card; MA plans issue their own cards with contact information on the back of this card
  • Check your patient’s eligibility; our OTP Medicare Billing & Payment Fact Sheet (PDF) has information on checking eligibility

Read the Medicare Advantage FAQs for more information.

Ensuring Continuity of Care for Dually Eligible Medicare Advantage Enrollees
On January 2, 2020, CMS released a Health Plan Management System (HPMS) Memo (PDF) to all Medicare Advantage organizations addressing continuity of care for dually eligible enrollees currently receiving OTP services through Medicaid.

Find Medicare-Enrolled OTPs
A list of Medicare-enrolled OTPs is now available and includes the OTP number assigned by the Substance Abuse and Mental Health Services Administration, the National Provider Identifier or NPI, address, and the date they enrolled in Medicare.  We will update the list every two weeks.

Page Last Modified:
09/24/2020 11:58 AM