decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2002 / AB-02-022
Subscribe or sign in to view the full article.
Article Overview
This article explains CMS guidance on coordination of benefits and Medicare secondary payer operations, including how responsibilities are divided among intermediaries, carriers, the COB Contractor, and related system processes. It is relevant to Medicare claims, MSP case handling, referrals, documentation flow, and ECRS/CWF operations, and includes implementation timing and contact information for contractor support.
Why This Topic Matters
It helps Medicare billing and claims staff understand which organization handles different MSP-related inquiries, case updates, referrals, and claim-related communications under the program memorandum framework.
Article Sections
-
Change Request 1558
Introduces the memorandum’s purpose and its relationship to earlier program instructions. Summarizes the overall scope of the update.
-
Updating Responsibilities on the Common Working File (CWF)
Describes responsibilities for maintaining MSP records and routing inquiries between contractors and the COB Contractor. Includes general examples of record maintenance and referral handling.
-
No-Fault, Workers’ Compensation, and Liability Referrals to the COB Contractor
Covers handling of inquiries and referrals involving no-fault, workers’ compensation, and liability matters. Addresses when cases remain with intermediaries/carriers versus when they move to the COB Contractor.
-
Intermediary and Carrier Claim Referrals to the COB Contractor
Explains general claim-processing responsibilities and the treatment of claim-related correspondence sent to the COB Contractor. Also addresses claim clarification workflows.
-
Intermediary/Carrier “I” Auxiliary Records
Summarizes when auxiliary records may be used and how related MSP information should be routed. Focuses on record handling and submission pathways.
-
COB Contractor MSP Development
Discusses contractor development activities for trauma-related, no-fault, and exhaustion-related MSP information. Includes broad operational responsibilities for development and record updates.
-
Paper Documentation
Provides general instructions on mailing paper documents and handling returned or pending materials. Also addresses routing of certain questionnaire responses and data match information.
-
Electronic Correspondence Referral System (ECRS)
Covers ECRS operating hours, contact pathways, version timing, and support escalation. Includes general status-check procedures and system support contacts.
-
COB Consortia Representatives
Identifies the limited situations in which consortia representatives may be contacted. Lists representative contacts and related issue categories.
What You Will Learn
- How CMS divides MSP and COB responsibilities among intermediaries, carriers, and the COB Contractor.
- What broad types of MSP-related inquiries and referrals are addressed in the memorandum.
- How CWF, ECRS, and paper documentation fit into the workflow described by the article.
- What operational support contacts and implementation dates are provided in the guidance.
Who Should Read This
- Medicare intermediaries
- Medicare carriers
- CMS/MSP coordinators
- COB Contractor staff
- Medicare claims operations staff
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com