Program_Memos / 2000 / AB-00-10

Why This Topic Matters

It documents how a specialized Medicare benefit was to be administered, including the operational steps needed to process claims and beneficiary elections. Readers need it to understand the scope of the program and the administrative updates tied to the July 1, 2000 implementation date.

Article Sections

1. Subject and Background

   Introduces the memorandum topic, the policy context, and the affected provider setting. Summarizes the general purpose of the instruction and the authorities referenced.

2. Election Requirements

   Describes the beneficiary election framework for receiving RNHCI benefits. Covers the broad requirements for establishing and maintaining an election.

3. Revocation of Election

   Addresses how an election may be revoked and the general effect of revocation on continued benefit eligibility. Explains the timing framework for later elections.

4. Payment

   Summarizes the payment context for RNHCI services and the general coverage relationship to inpatient care status. Identifies the type of services addressed by the memorandum.

5. Speciality Contractor

   Identifies the contractor responsible for RNHCI processing and continuity with the prior program contractor. Provides organizational context for administration of the benefit.

6. Responsibilities of Specialty Contractor

   Outlines the broad operational duties assigned to the specialty contractor. Includes election processing, claim handling, reporting, and payment adjustments.

7. Appropriate Bill Types

   Discusses the billing format and claim type framework used for RNHCI notices and claims. References the institutional billing formats and record structures involved.

8. Claims Processing Criteria

   Describes the claim-processing environment, including timing, file-system limitations, and contractor responsibilities. Also addresses how claims and coverage determinations interact with beneficiary elections.

9. Common Working File (CWF) Notification of Elections

   Explains how election notices are submitted and how the common working file is expected to respond. Covers general operational handling for election notifications.

10. CWF Notification of Revocations

    Explains how revocation notices are reported and processed through the common working file. Describes the high-level revocation notification workflow.

11. CWF Notification of Cancellations to Notifications of Elections and Revocations

    Describes how erroneous election or revocation notices are canceled and corrected. Covers the general notification pathway for those adjustments.

12. Completion of the Uniform (Institutional Provider) Bill (Form HCFA-1450) Notice of Election

    Provides field-by-field billing form completion guidance for the notice of election process. Focuses on the data elements needed for institutional provider reporting.

13. CWF Changes and Subsequent Non-RNHCI Contractor Actions

    Addresses how the common working file handles beneficiary election history and how other contractors should respond to related claims. Includes general handling of claims outside the RNHCI setting and required follow-up actions.

14. RNHCI Specialty Contractor MSN Messages

    Summarizes the beneficiary notice messages used by the specialty contractor for denials tied to the RNHCI benefit. Covers the general notification categories for claim outcomes.

15. Remittance Advice Notices

    Describes the remittance advice framework used when claims are denied under the RNHCI benefit. Covers the general code sets and message categories used in claim adjustment reporting.

16. Provider Notification

    Notes the expectation that providers be informed through routine contractor communications. Concludes with implementation and administrative timing information.