decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2002 / AB-02-014
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Article Overview
This program memorandum from CMS explains Common Working File edits affecting flu and pneumonia claims for fiscal intermediaries and carriers. It is relevant to Medicare claims processing staff, billing professionals, and coding teams who need to understand the scope of the edit changes, affected claim categories, associated reporting messages, and the effective and implementation dates.
Why This Topic Matters
The article documents a Medicare claims-processing update that affects duplicate-claim detection and related system edits for specific preventive service claims. It matters to organizations that submit or process Medicare flu and pneumonia claims because it outlines the operational changes and timelines tied to the Common Working File.
Article Sections
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Subject and Overview
Introduces the memorandum and the general purpose of the claims-processing update. Summarizes the Medicare claims context and the system change being announced.
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FI Edit
Describes the edit applied at the fiscal intermediary level and the claim elements reviewed. Explains the duplicate-claim processing framework for this edit category.
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Carrier Edits
Covers the carrier-level edits introduced for duplicate claim prevention. Includes the separate carrier edit categories and associated handling references.
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A/B Crossover Edit (FIs and Carriers)
Explains the crossover review involving outpatient and Part B claim history across processing channels. Describes the broad conditions under which claims are compared.
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Effective and Implementation Dates
Lists the dates tied to the memorandum and its operational use. Also notes the discard timeframe and contact guidance.
What You Will Learn
- The purpose of the Common Working File edit update for Medicare flu and pneumonia claims
- How the memorandum organizes edits for intermediaries, carriers, and crossover claim review
- Which broad claim-processing elements and reporting categories are affected
- When the memorandum becomes effective and when it is implemented
- The organizations and Medicare processing entities referenced in the update
Who Should Read This
- Medicare billing staff
- Coding professionals
- Claims processing personnel
- Provider revenue cycle teams
- Compliance staff
Codes Discussed
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