Claims Processing Instructions for the Designated Carrier (Rev. 866, 07-03-06) - Competitive Acquisition Program

by  Jared Staheli
July 9th, 2015

The designated carrier shall follow normal procedures to enroll the Drug Vendors as provider specialty type, 95, Competitive Acquisition Program (CAP) for Part B Drug Vendors.

A separate 4 position, alpha-numeric vendor identification number (VIN) shall be assigned to be used in the prescription number and a master list of which numbers are assigned to which vendors shall be kept.

The designated carriers shall forward the VIN to the carriers and to CMS 14 days after new CAP vendor contractors have been announced by CMS. CMS will post the VIN on the CMS Web site. Carriers shall download these identification codes from the CMS Web site and added them to the Carriers table.

For subsequent CAP years, this date will be the first Monday in November.

These codes shall be added to the Carriers table by 14 days after receipt.

The designated carrier shall track the name, the address, zip code, and phone number of each practice location/shipping address (location where the drugs will be administered), PIN, UPIN, (or NPI when effective), and e-mail (if available) of the physicians and physician groups and which vendors and which drugs they have chosen. In addition, the mailing/correspondence address (where the participating CAP physician can be contacted directly) for each physician shall also be tracked. This information shall be made available to CMS upon request.

On a quarterly basis, the designated carrier shall manually add additional HCPCS codes to the information above when received from the carriers. They shall add this information by 14 days after its receipt from the carriers.

The designated carrier shall only process CAP claims from approved drug vendors submitted in a HIPAA-compliant standard electronic format 4010A1 version (or later). All vendor claims shall be processed by the designated carrier. These will not include claims for United Mine Worker, Railroad or Medicare Advantage beneficiaries.

References:

Claims Processing Instructions for the Designated Carrier (Rev. 866, 07-03-06) - Competitive Acquisition Program. (2015, July 9). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/claims-processing-instructions-for-the-designated-carrier-rev-866-07-03-06-competitive-acquisition-program-27142.html

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