Clarification of Actions to Be Taken When Automated Duplicate Primary Payer (DPP) Claims Cannot Be Processed Due to Previous Secondary Payment Actions and Advanced Dates of Service on Claims
The purpose of this Change Request (CR) is to provide guidance to the A/B Medicare Administrative Contractors (MACs) and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) when they receive DPP claim adjustment requests on claims that the MACs or DME MACs previously processed for secondary payment. This instruction also provides definitive guidance to the A/B MACs and DME MACs concerning actions to be taken on DPP claims whose service date is five or more years in the past.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 24, 2024
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.