decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2002 / B-02-053
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Article Overview
This article is a CMS Program Memorandum dated July 31, 2002 that addresses HIPAA-related implementation of the ASC X12N 278 Version 4010 implementation guide for electronic referral certification and authorization. It is relevant to Medicare carrier operations, DMERC system maintenance, and administrative simplification compliance efforts. The memorandum outlines timing, scope, and general system development expectations for the standard, along with references to follow-up guidance.
Why This Topic Matters
Organizations supporting Medicare referral certification and authorization workflows need to understand the transition to the designated electronic standard and the implementation timeline. The memorandum helps readers identify whether the content applies to DMERC-related systems and broader HIPAA EDI planning.
Article Sections
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Program Memorandum and Transmittal Information
Identifies the issuing organization, transmittal details, date, and related administrative information for the memorandum.
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Subject and Background
Introduces the topic of electronic referral certification and authorization standardization under HIPAA and frames the operational context for the guidance.
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Implementation Guidance and Timeline
Describes the general implementation planning, system development, data mapping, and timing expectations associated with the standard.
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Scope, Applicability, and Effective Dates
Clarifies the limited Medicare fee-for-service scope, identifies the affected parties, and states the memorandum’s effective, implementation, and discard dates.
What You Will Learn
- The overall purpose of the memorandum and its relationship to HIPAA administrative simplification
- Which Medicare operational area the guidance applies to
- The general types of implementation planning referenced in the memorandum
- The timing framework associated with the memorandum and follow-up guidance
- The organizations and parties involved in the standard adoption process
Who Should Read This
- Medicare carriers
- DMERC system maintainers
- Healthcare EDI implementation teams
- Medical coding and reimbursement compliance staff
- Revenue cycle and administrative simplification professionals
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