decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2003 / B-03-038
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Article Overview
This article explains a CMS Program Memorandum issued to carriers and DMERCs about claim processing for oral anti-cancer drugs. It focuses on 837 transaction changes, use of NDC reporting, updates to DMERC free billing software and VIPS system handling, and the effective and implementation dates that applied in 2003. The memo is relevant to billing, claims processing, and system support staff working with Medicare drug claims and electronic claim formatting.
Why This Topic Matters
It helps Medicare claims and billing stakeholders understand a CMS operational change affecting how oral anti-cancer drug claims were submitted and processed in the 837 environment.
Article Sections
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Subject: Oral Anti-Cancer Drugs
Introduces the CMS memorandum and the claim-processing topic addressed in the update.
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Transaction and system processing updates
Describes changes to the X12N 837 format, DMERC billing software, and VIPS system handling related to claim submission and processing.
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Free billing software instructions
Summarizes the software-related submission values and where related claim data are reported in the revised billing workflow.
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Implementation timing and availability
Covers the dates for availability, implementation, and later discard of the memorandum.
What You Will Learn
- The general purpose of the memorandum and the Medicare claim-processing context it addresses.
- Which electronic claim transaction and system components were being updated.
- What types of submission and reporting fields were affected in the billing workflow.
- The operational dates associated with the memorandum and related software changes.
Who Should Read This
- Medicare billing staff
- DMERC personnel
- Claims processing staff
- Revenue cycle and billing software support teams
- Healthcare compliance staff
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