decisionhealth Newsletters, Answer Books - 2007 Issue 9 (September)
Medicare_Claims_Processing_Manual / Chapter_17 / 50
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Article Overview
This article covers Medicare claims-processing policy for drugs and biologicals, with emphasis on assignment requirements, how carriers and DMERCs handle unassigned claims, and the related remittance and notice messages used when claims are adjusted. It is relevant to billing staff, suppliers, physicians, and Medicare claims administrators who need to understand the operational guidance tied to drugs, biologicals, and related DMEPOS billing procedures.
Why This Topic Matters
The section addresses how Medicare expects certain drug and biological claims to be processed and communicated, which affects claim submission behavior, denial handling, beneficiary notices, and payer-system edits.
Article Sections
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A - Local Carriers
Covers assignment policy for carriers, including how claims involving drugs and biologicals are handled and the general messaging used when claims are processed under assignment-related rules.
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B - DMERCs
Covers DMERC handling of drug and biological claims, beneficiary-submitted claims, supplier submission issues, and related system and notice requirements.
What You Will Learn
- How Medicare assignment policy applies to drugs and biologicals in claims processing
- How carriers and DMERCs handle claims that include drugs, biologicals, and other services or items
- What kinds of remittance and Medicare notice messages are associated with these claims
- How supplier and licensing-related edits interact with drug and equipment claims
- Which organizations coordinate maintenance of drug-code and edit lists
Who Should Read This
- Medical coders
- Billing staff
- Durable medical equipment suppliers
- Pharmacies
- Physicians and nonphysician practitioners
- Medicare claims administrators
- Revenue cycle teams
Codes Discussed
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