The new Benefit Stage Qualifier (BSQ) 51 will be implemented on Jan 1, 2018 to assist in identifying Qualified Medicare Beneficiaries (QMB) at the point of sale. Federal law prohibits Medicare providers from balance billing a QMB for the Medicare cost share of Part A or Part B benefits.

Express Scripts will return BSQ 51 on the paid claim response for a Part B drug when the beneficiary is QMB eligible. A secondary message of "QMB-NO BALANCE BILLING-REMIT TO MEDICAID" will also be returned with BSQ 51. Pharmacies should continue to conduct due diligence in identifying QMBs even if BSQ 51 is not returned on a paid Part B claim.

*Please see attached for more information.