Program_Memos / 2003 / B-03-045

Why This Topic Matters

The article clarifies which Medicare claims must include diagnosis information and how carriers are expected to process claims that do or do not meet the requirement. It matters to organizations that prepare, submit, or adjudicate Medicare claims because it affects claim acceptance, unprocessable returns, and provider education workflows.

Article Sections

1. General Information

   Introduces the memorandum, its background, and the broader Medicare and HIPAA context for claim submission standards.

2. Policy

   Summarizes the claim submission policy and the general requirements for diagnosis information on Medicare carrier claims.

3. Implementation

   Describes how carriers and related systems are to handle claims under the updated requirements and outlines the operational changes involved.

4. Physicians Reporting Diagnosis Codes When A Diagnostic Test Is Ordered

   Addresses reporting responsibilities tied to ordered diagnostic and laboratory services and the role of physician or practitioner information.

5. Provider Education

   Covers CMS instructions for notifying affected providers and communicating the update through carrier education channels.

6. Business Requirements

   Lists implementation requirements assigned to carriers and the Common Working File for claim handling and system behavior.

7. Supporting Information and Possible Design Considerations

   Includes additional implementation notes, design considerations, interfaces, dependencies, and testing-related placeholders.

8. Attachment(s)

   Provides effective dates, implementation timing, discard information, and contact references for the memorandum.