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	A Medicare Set Aside Custodial Account is a fund set up to handle the administration of monies that have been determined should be used for payment of medical services. This fund has been established at the request of CMS (Centers for Medicare and Medicaid) and will be used to cover Medicare approved, injury related services only. This account has been funded and all treatment for these related injuries should be billed to Affiance Partners and not to Medicare. Affiance Partners is a company responsible for seeing that claims are paid from the Medicare Set Aside Fund in a timely and accurate fashion. By dealing with Affiance Partners directly, turn around time for payment is faster than dealing with insurance companies. If you happen to bill Medicare for services that are related to his/her injuries, you will receive a denial for payment with the notice that this claim should be billed to another payer. Thus, causing a delay in the provider receiving payment. By utilizing a Medicare Set Aside, this process will protect your patient’s future Medicare benefits. The Medicare Set Aside is approved through CMS (Center for Medicare and Medicaid) and has met the requirements necessary to maintain the integrity of the allocated funds. CMS stipulates that all bills are paid according to the State Workers Compensation Fee Schedule and adhere to Medicare’s coverage rules. Patient schedules an appointment with medical provider. Client presents Affiance Partners card to provider’s office/facility. If related to personal injury/workers compensation injuries, provider will bill Affiance Partners. If not related, provider will bill Medicare as usual. Prior authorization is not necessary; however please feel free to contact our office to verify the fund is still active. This is done by simply calling our toll free number and verifying coverage on the patient. By providing the appropriate billing code, this will allow us to further verify coverage of services as well. Contact Us Unlike Worker’s Compensation, Affiance Partners does not require any specialized reports for billing. Our billing process is the same as billing a major insurance provider for services rendered.      Our identification cards reflect a "settlement date". This date acts as the effective date for billing Affiance Partners. If you have received payment from Medicare for dates of service after the settlement date and those services are related to the patient’s injury, those funds must be reimbursed to Medicare. Forward those bills to Affiance Partners for the dates of service, and payment will be made according to the MSA. No. Medicare approved, injury related care should only be billed to Affiance Partners as a primary payer. If this fund becomes depleted at any time, you and the patient will be notified accordingly. This will alert you to change your billing to reflect billing Medicare as primary coverage. Once the fund receives additional monies, Affiance will again contact you and the patient to advise you change your billing. This does not happen frequently and usually is as simple as changing an insurance provider. Affiance Partners requires that billings be forwarded reflect the CPT and ICD.9 codes, as well as the date of service. We do ask that chart notes be forwarded with all billings. Please feel free to either mail or fax your claims to: Affiance Partners, 7775 Cooper Road, Cincinnati, Ohio 45242 or fax them to (513) 936-5186. Please be sure to utilize the identification number provided on the claimant’s card when submitting claims for payment.
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