decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2000 / B-00-04
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Article Overview
This January 2000 HCFA program memorandum explains how managed care organizations are handled under the indirect payment procedure for Medicare fee-for-service billing. It outlines the enrollment and credentialing steps, carrier responsibilities, durable medical equipment supplier enrollment touchpoints, and the administrative forms and contacts involved. The article is relevant to Medicare administrative staff, carriers, managed care organizations, and enrollment personnel who need to understand the processing requirements and implementation timing.
Why This Topic Matters
It clarifies administrative handling for indirect payments under Medicare managed care arrangements and helps avoid payment problems caused by inconsistent enrollment processing. The memorandum also identifies the forms, office contacts, and operational steps that carriers and MCOs must coordinate around.
Article Sections
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Subject and Purpose
Introduces the memorandum topic, scope, and administrative objective within Medicare managed care processing.
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Managed Care Organization Requirements
Describes the enrollment-related materials and coordination steps involved when a managed care organization seeks to bill under the indirect payment procedure.
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Carrier Requirements
Summarizes the responsibilities of carriers in handling enrollment and claim-processing matters related to indirect payment claims.
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Durable Medical Equipment
Covers the separate supplier-enrollment process referenced for durable medical equipment and related items.
What You Will Learn
- The administrative purpose of the indirect payment procedure for managed care organizations
- The roles of Medicare carriers, regional offices, and central office staff in enrollment processing
- The general forms and enrollment materials referenced in the memorandum
- The operational considerations for claims processing timeliness and supplier enrollment
Who Should Read This
- Medicare carriers
- Managed care organizations
- Provider enrollment staff
- Health care billing and compliance staff
- Durable medical equipment suppliers
Codes Discussed
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