Application of ASCA Enforcement Review Decisions Made by Other Medicare Contractors to the Same Providers When Selected for ASCA Review by the Railroad Medicare Carrier, Elimination of References to Claim Status and COB Medicare HIPAA Contingency Plans and Changes to Reflect Transfer of Responsibility for Medigap Claims to the COBC Contractor
Due to distribution of RR retirees, many providers submit fewer than 10 claims a month to the RR Medicare Carrier (RMC) and have been allowed to continue to submit paper claims to the RMC. The same providers treat non-RR Medicare beneficiaries and in many cases do submit more than 10 claims a month to other Medicare contractors. ASCA electronic claim filing exceptions apply to Medicare overall and do not differentiate based on contractors or between RR and non-RR contractors. By adding ASCA information from SuperPES to the PES file sent the RMC weekly, the RMC can apply decisions that providers are ineligible to submit paper claims and other ASCA decisions to the same providers when they bill the RMC. Elimination of References to Claim Status and COB Medicare HIPAA Contingency Plans and Changes to Reflect Transfer of Responsibility for Medigap Claims to the COBC.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 15, 2007
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