decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2001 / B-01-73
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Article Overview
This article covers a CMS Program Memorandum directed to carriers and DMERC contractors about a one-time review of deceased physicians’ UPINs, updates to provider and registry files, and claim-processing impacts tied to CMS system edits and contractor notices. It is relevant to Medicare claims, provider enrollment, DMERC operations, and staff training because it outlines the administrative workflow, reporting, and communication steps associated with the review.
Why This Topic Matters
It helps Medicare contractors and billing staff understand a specific CMS operational update affecting DMERC claim screening, provider data maintenance, and contractor communications.
Article Sections
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Program Memorandum and Subject
Introduces the CMS transmittal, date, change request, and overall administrative topic addressed by the memorandum.
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Background
Provides the policy context and operational reasons for the review, including references to Medicare physician identification and claim submission requirements.
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Part B Contractors
Describes contractor responsibilities for reconciling files, validating provider information, handling discrepancies, and maintaining documentation and status reporting.
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CWF
Explains the Common Working File’s role in maintaining the deceased physician list and screening DMERC claims within the system workflow.
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DMERCs
Summarizes DMERC operational actions for claim handling, notices, education, and coordination when screening results identify provider record issues.
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Provider Education
Covers communication and training activities intended for customer service staff and suppliers regarding the memorandum’s operational changes.
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Attachment
Lists implementation timing, budget handling, retention guidance, and contact information related to the memorandum’s rollout.
What You Will Learn
- The administrative purpose of the memorandum and who it applies to
- How CMS expected contractors to review and update provider records
- The systems and contractor workflows involved in DMERC claim screening
- The types of education and notice activities required for implementation
- The effective and implementation timing for the update
Who Should Read This
- Medicare contractors
- DMERC staff
- Part B provider enrollment staff
- Medical billing and claims staff
- Provider education and customer service staff
Codes Discussed
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