HI 01005.020 Group Payer Arrangements

The policies and procedures set forth in HI 01001.230 ff. apply to organizations which wish to pay premiums on behalf of Premium-HI enrollees. Existing SMI premium group payers must notify CMS if they wish to include Part A enrollees under their arrangements. Since they have already met the basic requirements for establishing a group payer arrangement, there is no need for them to represent a substantial number of Part A enrollees. (See HI 01001.240 C.)

Organizations which are initially requesting establishment of a group payer arrangement (whether for SMI premiums only, HI premiums only, or both) must meet the requirements of HI 01001.230 with respect to the total enrollees for whom they are paying. That is, a substantial number of either Part A or Part B enrollees will be required. In addition, they will complete an arrangement form which spells out their premium payment responsibilities.

Group payers are required to report Part A enrollees separately from Part B enrollees to simplify recordkeeping. To clarify this reporting, a separate group agency code is assigned for each type of premium payment.

Currently, SMI group payers are assigned three position reporting codes beginning with the letters A, B, J, or K and followed by two digits, e.g., A14, A32, B03, J81, K55, K36 (see HI 01005.809). Part A group payers other than States (see HI 01005.025) are assigned three position reporting codes beginning with X, and two digits. Consistency is maintained between Part A and Part B group codes as follows:

  • An agency maintains the same digit identifiers in each code. For example, agency A15 upon notifying SSA that it is going to pay Part A premiums would be assigned an HI agency code of X15; agency J80 would be assigned HI agency code X80; agency K36 would be assigned HI agency code X36; B03 would be assigned agency code X03.

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HI 01005.020 - Group Payer Arrangements - 12/06/2001
Batch run: 01/27/2009