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Medicare Advantage Hospice VBID

Welcome to Medicare Advantage Hospice VBID

Effective January 1, 2021, HMSA Akamai Advantage® individual plans will participate in the Hospice Benefit Component of the Medicare Advantage VBID (Value Based Insurance Design) model. Under the Hospice Benefit Component, the Medicare-covered hospice benefit will be included in the HMSA Akamai Advantage plan benefit package. In addition, this program will allow HMSA to provide transitional concurrent care services to members who are enrolled in Medicare-covered hospice, a benefit that is not available under Original Medicare. For more information, see the Transitional Concurrent Care medical policy.

The HMSA Medicare Advantage Hospice VBID model is ending effective December 31, 2024. Original Medicare, rather than our plan, will pay hospice providers for Medicare-covered hospice services. Transitional Concurrent Care, as part of the Hospice VBID model will also end effective 12/31/2024.

Medicare Advantage Hospice VBID (1/1/2021 – 12/31/2024)

The MA Hospice VBID, along with Transitional Concurrent Care and Supportive Care, provide flexible options for members facing serious or life-threatening disease to utilize palliative care services. Hospice coverage starts from the effective date of election until the date of discharge or when the patient chooses to revoke hospice benefits.

This page includes information about eligibility, operational guidelines, contact information, and billing and claims submissions details.

*The resource below will be updated with additional information about this program as it becomes available. Refer to the Change History at the bottom of this page.

Eligibility

To be eligible for the Medicare Advantage Hospice VBID benefit, the member must:

  • Must be enrolled in an HMSA Akamai Advantage (PPO) individual plan at admission – see list of eligible plans below.
  • Must meet Medicare Hospice eligibility criteria to enroll in the Hospice benefit
  • Terminal prognosis of 6 months or less
  • Must elect Hospice
Plan Name Coverage Code Contract ID and PBP
HMSA Akamai Advantage Standard (PPO) 708 H3832-007
HMSA Akamai Advantage Standard Plus (PPO) 709 H3832-008
HMSA Akamai Advantage Complete (PPO) 706 H3832-009
HMSA Akamai Advantage Complete Plus (PPO) 707 H3832-010
HMSA Akamai Advantage Dual Care (PPO-SNP) 696 H3832-011

Both coverage code and contract ID and PBP can be found on the member’s ID card.

HMSA Medicare Advantage ID card showing member information and highlighted coverage code H3832 010.

You can verify the member’s eligibility on the Hawaii Healthcare Information Network (HHIN+), which is HMSA’s website for providers to access member plan and benefit information. You can view the hospice benefit by clicking on the coverage code, or you can go directly to the Benefits section to get the coverage information.

Please see these HHIN+ Easy User Guides for more information about how to use HHIN+:

Billing, Claims Submission and Documentation

Under the model, all Hospice Providers must follow Medicare guidelines to submit claims to HMSA for payment. VBID Hospice – Claim Sample [PDF]

In addition, under the model hospice providers must continue to submit their claims to the MAC (Original Medicare), for reporting purposes. See: MLN Matters 11754: Value-Based Insurance Design(VBID) Model – Implementation of the Hospice Benefit Component [PDF]

Find more information on billing and payment for hospice services in the Medicare Claims Processing Manual [PDF], Chapter 11.

Services rendered within the State of Hawaii
Operational Guidelines for In-Network Providers

Participating providers should follow the requirements for billing and payment agreed to in the contract. Participating providers (also referred to as in-network providers) should submit the NOE and claims for hospice services, either facility or professional services, to HMSA for patients enrolled in a model participating plan in the same way that you submit to Original Medicare.

Services rendered outside the State of Hawaii
Operational Guidelines for In-Network and Out-of-Network Providers

If you operate outside of the State of Hawaii you should submit the NOE and claims for hospice services, either facility or professional services, to your local Blue plan. The local Blue plan will transmit the claim information to HMSA through the BlueCard system for benefit application.

  1. Identify the Blue Cross Blue Shield (BCBS) plan in your area: https://www.bcbs.com/bcbs-companies-and-licensees
  2. Submit NOE and all hospice claims for the patient enrolled in an HMSA Medicare Advantage VBID participating plan to the local BCBS plan in your area.
  3. HMSA will work with your local BCBS plan to process and pay the claim(s).

Notice of Election

To be covered by the Medicare hospice benefit, a beneficiary must sign an election statement, known as the Notice of Election (NOE). The election statement begins the hospice stay. The hospice provider notifies HMSA that the hospice stay has begun by submitting the claim via:

  • Electronic Data Interchange (EDI) 837I claim transaction
  • Hardcopy claim form

The NOE processes through HMSA’s claim systems, which updates the member’s record and uses the information to adjudicate hospice claims.

Hospice providers should also send informational claims to the MAC (Original Medicare) under this model. See: MLN Matters 11754: Value-Based Insurance Design(VBID) Model – Implementation of the Hospice Benefit Component [PDF]

Hospice providers must file the NOE within five calendar days after the hospice admission date to be considered timely. This is counted as the date that HMSA receives the NOE.

Ways to Submit Your Notice of Election

Electronic Submission of NOE (837)

Using your existing billing software or clearinghouse is the preferred method for NOE submission. The NOE may be transmitted via 837 transaction. See the NOE Companion Guide [PDF] for transaction Information details and instructions relating to the non-standard use of the 837 to transmit a Hospice NOE. See the additional Resources below for Submission Guidelines.

HMSA eClaims on HHIN+

HMSA eClaims Systems is a direct data entry option for providers who do not have billing software or a clearinghouse. To learn more about this application, please reference the HMSA eClaims System for an overview. This online tool has been updated to support electronic submission of the NOE (Type of Bill 81A).

For more information about HMSA eClaims, please contact our ETS Outreach Unit at:

See Additional Resources below for Submission Guidelines.

Hardcopy claim Submission

As an alternative, you may submit your NOE on a paper UB-04 claim form. Refer to the UB-04 Claim Form – General Instructions page for details on submitting your paper claim. Refer to the HMSA Directory – Claims for the appropriate claims filing address.

Additional Claim Requirements

Facility (UB-04) claims must include certain required information or they will be denied. in addition to using the correct form, they should also include:

  • Type of Bill (e.g., 81A)
  • Total charge – this field must include a dollar amount. For an NOE, the amount should be $0.
  • HMSA Provider ID (10-digit)
Line charges should also include:
  • Hospice Election Rev Code – 0650
  • Q Codes (e.g., Q5001 – Q5010) (HCPS) need to be indicated for informational purposes
  • Service Date (Date of Election)
  • Billed units: 1
  • Occurrence Code 27 (should be included on the NOE)

Additional Resources

  • VBID Hospice – NOE Sample UB-04
  • Hospice Notice of Election Submission Guidelines – HMSA Medicare Advantage Hospice VBID
  • Notice of Election: Submitting the NOE Hardcopy JOB AID

Contacts

Questions about the contracting process for hospice, how to verify benefits and enrollee eligibility for the model, or how to correctly submit hospice claims to our organization for payment:

Hospice Network Administrative Contact & Clinical and Patient Support Contact

For services rendered outside the State of Hawaii

  • Claim inquiries should be sent to your local Blue plan.

Resources

Medicare Hospice VBID Training

CMS Innovation Center Resources

Claims Submission Guidance: Medicare Fee for Service

CURRENT AS OF 08/03/2026

Revision History

Date Nature of Revision
08/03/2026 Migrated to new platform.