Omb 0938 1013 form-2025

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The document provides detailed instructions for entities required to disclose their prescription drug coverage status to the Centers for Medicare & Medicaid Services (CMS) under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. It outlines the definition of 'creditable coverage,' the entities obligated to submit disclosures, the timing and method for submission, and specific steps to complete the online Disclosure to CMS Form. Additionally, it explains exemptions for certain plans and provides guidance on how to report changes in coverage status.

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What is a CMS form used for?

The Health Insurance Claim Form (CMS-1500) is used by Allied Health professionals, physicians, laboratories and pharmacies to bill supplies and services to the Medi-Cal program. Providers are required to purchase CMS-1500 claim forms from a vendor. Claim forms ordered through vendors must include red drop-out ink.

What is the purpose of CMS?

If you receive a settlement, judgment, award, or other payment related to this claim and Medicare determines that it has made conditional payments that must be repaid, you will get a demand letter.

Who sends a creditable coverage notice?

Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drug coverage provided under the plan is creditable or non-creditable. This notification must be provided prior to October 15th each year.

What is a CMS form?

Non-creditable coverage: A health plans prescription drug coverage is non-creditable when the amount the plan expects to pay for prescription drugs for individuals covered by the plan in the coming year is, on average, less than that which standard Medicare prescription drug coverage would be expected to pay.