Medicare_Claims_Processing_Manual / Chapter_8 / 60.7.2

Why This Topic Matters

Suppliers and billing professionals need this guidance to recognize the billing framework Medicare expects for this ESRD-related drug and to understand which claim-processing pathways apply when required information is missing or coverage criteria are not met.

Article Sections

1. Darbepoetin Alfa (Aranesp) Supplier Billing Requirements

   Introduces the Medicare billing context for darbepoetin alfa in ESRD dialysis and identifies the claim formats and parties addressed by the guidance.

2. Claim Submission Requirements and Required Information

   Describes the claim elements and electronic claim data references discussed for Method II submissions, including where certain billing information is reported.

3. Coverage Handling and Claims Processing

   Summarizes how claims are processed when coverage criteria are not met or required information is missing, including the general categories of messages used.

4. Payment and Pricing File Reference

   Notes the payment framework referenced for reimbursement and the source cited for obtaining applicable rates.