Program_Memos / 2000 / AB-00-111

Why This Topic Matters

It helps billing and claims-processing staff understand how Medicare handled clinical trial claims for managed care enrollees during the transition to updated systems and editing rules. The guidance is relevant for contractors and providers who need to recognize when claims require special handling or resubmission.

Article Sections

1. Revised Claims Processing Instructions

   Overview of the memorandum’s purpose and the broad claims-processing changes for clinical trial services furnished to managed care enrollees.

2. CWF Editing Of Clinical Trial Claims For Managed Care Enrollees — Carriers and DMERCs

   Discussion of centralized claims editing behavior, reject handling, and the transition to updated system processing for carriers and DMERCs.

3. Payment and Standard Systems and CWF Editing of Clinical Trial Claims For Managed Care Enrollees — Intermediaries and RHHIs

   Guidance for intermediaries and RHHIs on payment processing, system acceptance, and resubmission of previously handled claims.

4. Billing Requirements for Intermediaries

   Billing and form-submission requirements for intermediary processing of the affected clinical trial claims.

5. Contractor Submission of Claims for Clinical Trial Services Paid Outside of CWF

   Instructions for reporting claims that were paid outside the centralized editing environment and later need to be posted to claims history.