decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2003 / AB-03-145
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Article Overview
This article explains CMS instructions for contractors other than the specialty intermediary when handling claims tied to Religious Nonmedical Health Care Institution elections. It covers the background of the benefit, how contractors should review rejected claims, how to record review outcomes, and how beneficiary notices should reflect the results. The guidance is relevant to Medicare claims processing staff, contractor operations teams, and anyone tracking CMS program memorandum changes affecting RNHCI claims handling.
Why This Topic Matters
It helps readers understand a Medicare-specific claims workflow that affects payment processing, beneficiary election status, and contractor review procedures. The article also highlights implementation timing and record-keeping requirements that matter for operational compliance.
Article Sections
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I. General Information
Provides background on the memorandum and the RNHCI benefit, including the scope of the instructions for non-specialty Medicare contractors.
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Election Requirements
Summarizes the election framework for RNHCI benefits and the general nature of the beneficiary election and revocation process.
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Revocation of Election
Describes the general circumstances under which an election may be revoked and how revocation-related claims are handled by contractors and claims systems.
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B - Policy
Identifies the statutory and regulatory authorities associated with the RNHCI benefit.
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II. Business Requirements
Lists the operational requirements for contractors, including claim suspension, review, annotation, and notice handling.
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III. Supporting Information and Possible Design Considerations
Provides supplemental implementation notes, examples, and general design-related observations for contractor processing.
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A. Other Instructions
Contains additional guidance and examples intended to support contractor review processes.
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B. Design Considerations
Notes whether any design considerations are present.
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C. Interfaces
Notes whether interface considerations are present.
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D. Contractor Financial Reporting /Workload Impact
Notes whether financial reporting or workload impacts are present.
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E. Dependencies
Notes whether dependencies are present.
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F. Testing Considerations
Notes whether testing considerations are present.
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IV. Attachment: Field Locations for Excepted/Nonexcepted Indicators
Provides attachment information about claim record fields and implementation dates related to the indicator process.
What You Will Learn
- The purpose and scope of CMS instructions for contractors handling RNHCI-related claims
- How the article frames the election and revocation context for the benefit
- What operational review and record-update topics are covered for claims rejected by claims systems
- What implementation and attachment information is included for contractor reference
Who Should Read This
- Medicare contractors
- Claims processing staff
- RNHCI policy staff
- Revenue cycle and compliance teams
- Healthcare billing professionals tracking CMS guidance
Codes Discussed
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