Program_Memos / 2000 / AB-00-71

Why This Topic Matters

The memorandum helps contractors and participating entities identify demonstration claims, process enrollment-related transactions, and apply the correct administrative handling for services tied to the coordinated care initiative.

Article Sections

1. Subject and Background

   Introduces the demonstration and explains its Medicare context, participating entities, and overall administrative purpose.

2. Enrollment

   Describes the beneficiary election, revocation, and related enrollment transaction workflow used for the demonstration.

3. Responsibilities of Intermediary

   Summarizes intermediary responsibilities for processing demonstration-related election notices and outpatient claims.

4. Appropriate Bill Types

   Identifies the bill type formats and related claim record elements used for demonstration transactions.

5. CWF Notification of Elections

   Explains how election notices are transmitted and acknowledged through the claims history process.

6. CWF Notification of Revocations

   Describes how revocation notices are handled and confirmed in the claims history process.

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

   Covers cancellation and correction handling for previously submitted enrollment-related notifications.

8. Completion of the Notice of Election by CCEs

   Lists the data elements required on the election record and the corresponding electronic claim data mappings.

9. Billable Codes Under the MCCD

   Notes that special demonstration HCPCS codes are assigned and referenced in an attachment.

10. Denial of Services Provided in the MCCD

    Addresses review and payment handling for claims that were inappropriately denied under the demonstration.

11. CWF Validation of Claims Submission

    Outlines the validation steps used to check beneficiary eligibility, participation period, and demonstration limits.

12. Claims Processing Instructions for Both Intermediaries and Carriers

    Describes shared processing guidance for electronic and paper claims and the demonstration identifiers used on claims.

13. Provider Remittance Notices

    Explains how denial reporting and remark coding are handled on remittance notices for demonstration claims.

14. MSN Messages

    Provides beneficiary message guidance for claims denied or rejected because of enrollment or participation issues.

15. Carrier Claims Processing

    Summarizes carrier-side processing rules for demonstration claims and service submission requirements.

16. Services Outside the List of Billable Codes Billed with the Special Processing Number (SPN) 37

    Addresses handling of claims that fall outside the demonstration coding framework.

17. Exceptions to Carrier’s Normal Coverage Policy

    Notes that ordinary coverage edits are bypassed only for claims tied to enrolled demonstration participants.

18. Electronic Carrier Claims

    Identifies the claim record locations used to convey demonstration identifiers in electronic carrier submissions.

19. Intermediary Claims Processing

    Summarizes intermediary-side processing instructions for demonstration claims and provider reporting.

20. Exceptions to Intermediary’s Normal Coverage Policy

    Describes how coverage edits are handled for demonstration claims on the intermediary side.

21. Attachments

    Contains the demonstration code attachments with site-specific HCPCS references and related tables.

22. ATTACHMENT I — Medicare Coordinated Care Demonstration HCPCS Code Request for Site One (Georgetown)

    Lists the initial site’s demonstration HCPCS references along with general code table information.

23. ATTACHMENT II — Medicare Coordinated Care Demonstration HCPCS Codes, Definitions to Follow as Sites are Awarded

    Provides additional site-based HCPCS references for later demonstration sites and their table structure.