Medicare_Carriers_Manual / 4123 / 4123

Why This Topic Matters

It helps suppliers, billing staff, and Medicare claims processors understand when assignment is required, how certain claims are handled, and how related system edits and notices are applied.

Article Sections

1. Ed. Note: For further information see

   A short editorial note pointing readers to related guidance in another chapter.

2. 4123. Durable Medical Equipment Regional Carriers (DMERCs)-Mandatory Assignment for Drug Claims

   General policy guidance on mandatory assignment for DMERC-billed drugs and biologicals, including the scope of the requirement and an exception noted in the text.

3. Beneficiary-Submitted Claims

   Instructions describing how claims submitted by beneficiaries are handled, including notice usage and processing of mixed claims.

4. Supplier-Submitted Unassigned Claims

   Guidance for supplier-submitted unassigned claims, including claim processing outcomes, remittance messaging, and related notice usage.

5. The Non-Licensed Pharmacy Initiative

   Background on pharmacy licensure requirements for suppliers billing certain drug-related claims and the associated claims-processing edits.

6. List of Affected HCPCS Codes

   Discussion of how DMERCs are to identify and maintain affected HCPCS code lists for billing and edit purposes.