Program_Memos / 2002 / B-02-063

Why This Topic Matters

The article clarifies how claims systems were expected to handle diagnosis code validity across an annual code update cycle, including the transition period and carrier system implementation requirements. It helps readers understand the operational impact of CMS instructions on claim processing and system compliance.

Article Sections

1. Program Memorandum and subject overview

   Introduces the CMS transmittal, the reason for the memorandum, and the overall policy area addressed. It also identifies the systems and carriers affected by the instruction.

2. Date-of-service processing requirements

   Describes the general requirement to process diagnosis code validity using the date of service and references the HIPAA-related compliance context. It outlines the timing framework for implementation across affected systems.

3. Carrier system updates and effective dates

   Summarizes the system handling changes described for Medicare carrier processing and the related effective-date concepts. It also notes the treatment of truncated diagnosis entries and annual update timing.

4. Grace period and example scenarios

   Explains the transitional period described in the memorandum and illustrates how the update cycle affects claims during that window. The section includes illustrative examples tied to diagnosis code update timing.

5. Provider communication and implementation dates

   Covers the notice-and-awareness expectations for providers and software vendors, along with the stated implementation and discard dates. It also mentions budget and contact information.