Program_Memos / 2003 / AB-03-058

Why This Topic Matters

It helps readers identify whether a Medicare claim may require post-payment correction when managed care enrollment affected payment responsibility, and it outlines the administrative framework surrounding those adjustments.

Article Sections

1. Program Memorandum and Transmittal Information

   Identifies the issuing federal agencies, transmittal details, and the effective and implementation timing for the memorandum.

2. Subject and System Processing Overview

   Describes the claims-processing context for fee-for-service claims that overlap managed care enrollment periods and the role of CMS system edits and history checks.

3. Claims History Review and Informational Response Handling

   Summarizes how claim information is identified, transmitted, and routed for subsequent processing within the contractor and shared-system environment.

4. Carrier Instructions

   Covers carrier-side handling of deductible updates, recovery procedures, and appeal-related references to Medicare manual guidance.

5. Fiscal Intermediary Instructions

   Covers fiscal intermediary handling of deductible updates, recovery procedures, and appeal-related references to Medicare manual guidance.

6. Messages To Be Used With Denials Based On Unsolicited Response

   Provides the categories of denial messaging used in remittance advice, provider communications, and beneficiary notices.

7. Provider Notification and Implementation Notes

   Notes that a separate provider education article will be issued and restates the implementation and retention dates for the memorandum.