Program_Memos / 2001 / AB-01-30

Why This Topic Matters

It helps readers determine whether the memorandum applies to Medicare demonstration claims and which administrative and processing topics are covered before reviewing the full guidance.

Article Sections

1. Subject and summary of changes

   Summarizes the purpose of the memorandum and the categories of updates being made to prior demonstration instructions.

2. Background

   Provides context for the Medicare Coordinated Care Demonstration, its participating entities, and the general structure of the program.

3. Enrollment

   Describes the demonstration enrollment and revocation workflow, the roles of the intermediary and CWF, and related beneficiary eligibility requirements.

4. Responsibilities of Intermediary

   Outlines intermediary responsibilities for election notices and claims handling for the demonstration.

5. Appropriate Bill Types

   Identifies the bill type format and related claim record requirements used for demonstration transactions.

6. CWF Notification of Elections

   Explains how election notices are submitted and acknowledged through CWF processing.

7. CWF Notification of Revocations

   Covers the handling of revocation notices and how they are reported through CWF.

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

   Describes cancellation handling for previously submitted election and revocation transactions.

9. Completion of the NOE by CCEs

   Lists the claim and enrollment data elements used to complete the notice of election process.

10. Code Structure

    Presents the structure of the bill type identifiers used in the demonstration enrollment workflow.

11. Billable Codes Under the MCCD

    Discusses the demonstration code set, site-specific billing setup, and the distribution of claims processing responsibilities.

12. Pricing

    Describes how payment amounts are established for demonstration procedures across sites.

13. Denial of Services Provided in the MCCD

    Addresses claims that were improperly denied and the need to ensure local policies do not conflict with the demonstration.

14. CWF Validation of Claims Submission

    Summarizes the validation steps CWF applies to demonstration claims and the conditions that can lead to rejection.

15. Claims Processing Instructions for Both Intermediaries and Carriers

    Covers electronic claim submission, contractor jurisdiction, and the high-level processing framework for demonstration claims.

16. Provider Remittance Notices

    Explains remittance handling, adjustment reporting, and remark code use for demonstration-related denials and payment processing.

17. MSN Messages

    Provides beneficiary notice messaging associated with demonstration enrollment and participation issues.

18. Carrier Claims Processing

    Describes carrier-side processing for demonstration claims and related coverage handling.

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

    Addresses claims submitted with the demonstration processing number outside the applicable date range.

20. Exceptions to Carrier’s Normal Coverage Policy

    Notes exceptions to standard coverage edits for demonstration claims.

21. Electronic Carrier Claims

    Identifies where the demonstration processing number appears in electronic carrier claim formats.

22. Intermediary Claims Processing

    Describes intermediary-side processing for the Georgetown demonstration site.

23. Exceptions to Intermediary’s Normal Coverage Policy

    Notes exceptions to standard coverage edits for intermediary-handled demonstration claims.

24. Attachments

    Contains the site-specific demonstration code listings, payment references, and contractor assignment tables.