decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2001 / AB-01-76
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Article Overview
This article explains a HCFA program memorandum directed to Medicare intermediaries, carriers, and DMERCs about the Coordination of Benefits contractor. It covers the transition of Medicare Secondary Payer-related investigation and information-gathering functions, provider outreach expectations, and where different types of inquiries and record updates should be directed. The content is relevant to Medicare billing staff, providers, suppliers, and payer support teams that handle coordination-of-benefits and secondary payer issues.
Why This Topic Matters
It helps organizations understand the administrative shift in responsibility for Medicare Secondary Payer activities and where to route coverage, inquiry, and record-maintenance matters.
Article Sections
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Program Memorandum and Background
Introduces the memorandum, its issuance date, related prior transmittals, and the general administrative context for the change.
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Outreach to Providers
Describes the provider-bulletin outreach expectations and the requirement to distribute and post the attached fact sheet.
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Next Steps in Outreach and Education
Addresses continued outreach and education activities and references the applicable budget and performance framework.
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COB Contractor Fact Sheet for Providers
Presents the provider-facing fact sheet covering the coordination-of-benefits initiative, information gathering, claims-related contacts, MSP auxiliary records, and contractor contact guidance.
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Information Gathering
Summarizes the general methods and programs used to identify situations involving other health coverage and Medicare as payer.
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Provider Requests and Questions Regarding Claims Payment
Explains how claims processing questions, payment-related inquiries, and MSP investigation matters are divided among local contractors and the COB contractor.
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Medicare Secondary Payer Auxiliary Records in HCFA’s Database
Describes the handling of MSP information in HCFA’s database and the role of external reporting for updates to beneficiary coverage information.
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Termination and Deletion of MSP Auxiliary Records in HCFA’s Database
Covers the general handling of records that no longer apply and the reporting of invalid MSP information for review.
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Contacting the COB Contractor
Provides general contact guidance and service availability information for MSP-related inquiries.
What You Will Learn
- How HCFA organized coordination-of-benefits responsibilities for Medicare Secondary Payer matters
- What provider outreach and bulletin distribution actions were expected
- Which general types of MSP-related questions were routed to local contractors versus the COB contractor
- How MSP information and auxiliary records were handled at a high level
- Where providers were instructed to direct different categories of Medicare coverage and inquiry issues
Who Should Read This
- Medicare providers
- Billing and office staff
- Suppliers
- Intermediaries and carriers
- DMERC staff
- Payer and coordination-of-benefits support teams
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