Currently, after A/B Medicare Administrative Contractors (MACs), Durable Medical Equipment MACs (DME MACs), fiscal intermediaries (FIs), and carriers have finalized payment of incoming provider/physician/supplier claims, they transmit the adjudicated claims to the Coordination of Benefits Contractor (COBC) for Medicare claims crossover purposes.  The COBC translates the claims into the required HIPAA ANSI 837 claim formats for claims crossover purposes, then subjects them to HIPAA compliance validation; normally, it is within this module that HIPAA compliance problems are identified.

When the COBC identifies HIPAA compliance problems, it notifies the A/B MAC, DME MAC, FI, or carrier that its processed claims could not be crossed over.  This entity, in turn, mails the affected provider/physician/or supplier a special letter that indicates "The claim(s) could not be crossed over due to claim data errors..." and includes the specific error code (eg. H51000) with accompanying error description.  The assumption is that once providers/physicians/suppliers receive these letters from Medicare, they will then take steps to bill their patients' supplemental payer for the balances owed after Medicare.

In recent weeks, three issues have arisen that were caused by defects in the COBC compliance validation process:

• H51108:  '237' is not a valid 'Line Level Adjustment Reason Code'
  • Issue:  COBC was incorrectly rejecting claims that contained a claim adjustment reason code (CARC) 237.  The rejection occurred because COBC's vendor inadvertently did not have reason code 237 loaded to its CARC table.
  • Fix date:  Mon Jan 16
  • H20203:  Element CLM16 is present though marked 'Not Used'
    • Issue:  COBC's vendor's translation routine was copying the value from 2300 CLM20 and incorrectly creating that value within 2300 CLM16 ('Not Used')
    • Projected fix date: Mon Feb 27
    • Steps taken:  As of the week of Mon Feb 13, CMS asked its A/B MACs, DME MACs, FIs, and carriers to hold the letters they would normally generate that contain error code H20203.  Effective Mon Feb 27, our Medicare contractors will be able to resend the affected claims to the COBC so that they may be successfully crossed over.
    • H45255:  The Other Subscriber Primary Identifier (2330A NM109) cannot be the same as the group or policy number (2320 SBR03)
      • Resolution:  COBC scrubs the duplication that is present in 2320 SBR03
      • Project fix date:  TBD, but hopefully not later than early April 2012
      • NOTE:  Currently, error H45255 is prohibiting the sending of Medicare crossover claims to North Dakota Medicaid in certain instances.
      • Steps taken:  CMS is requesting that Medicare contractors hold the letters that would normally be generated for error code H45255.  Once a fix date is identified for this issue, CMS will notify the Medicare contractors to resend the affected claims to the COBC so that they may be successfully crossed over.

CMS reports that they are actively partnering with the COBC to address these problems as quickly as possible.

Noridian Medicare Updates

• Main Menu Options Have Changed on IVR System
  On Wednesday, February 29, 2012, Jurisdiction D introduced a new menu option (Appeals) into the Interactive Voice Response (IVR) System. With this addition the main menu options have changed. See the key below to determine how to select the appropriate optio
  n

The IVR Guide [PDF] and IVR At-A-Glance [PDF] have also been updated to reflect this new information.

• Appeal Status Now Available Through IVR System
  Effective February 29, 2012, suppliers are able to obtain appeal status through the NAS Jurisdiction D Interactive Voice Response (IVR) System, 1-877-320-0390. Suppliers should be aware that it takes ten days from the date we receive an appeal for it to be accessible from the IVR. Below are instructions on how to utilize this new menu option. To access the appeals option from the main menu, key the touch tone option "8" or speak the vocal option "appeals". The six required elements for the appeal status inquiry include National Provider Identifier (NPI), Provider Transaction Access Number (PTAN), last five digits of supplier Tax Identification Number (TIN), Beneficiary's Medicare number, Beneficiary's name as it appears on the Medicare card, and 14-digit claim control number (CCN) as listed on the remittance advice as the Internal Control Number (ICN) field.

An article with more details on how to use the IVR to obtain appeal status can be accessed from the NAS DME website,  https://www.noridianmedicare.com/dme/news/docs/2012/02_feb/appeal_status_now_available_through_ivr_system.html.

The NSCAC is an organization comprised of individuals that are representing their respective DME MAC Jurisdiction Advisory Committees/Councils in all four jurisdictions in the United States. It was formed with the purpose of; improving communication between the National Supplier Clearinghouse (NSC) and the supplier community, suggesting to the NSC targeted educational opportunities regarding supplier number obligations to DMEPOS suppliers, and creating a problem solving/communication link between the DMEPOS supplier community and the NSC. The NSCAC meets regularly with the senior management of the NSC. The NSC has recognized the NSCAC as a liaison to the industry.

Use this form/email to submit questions to the NSCAC. The compiled questions on a quarterly basis will then be submitted to the NSC for response. These meetings are intended to discuss and resolve broad issues and problems with the NSC, rather than individual provider's issues. When you do submit a question, attach appropriate documentation if needed. NSC personnel answer the questions in writing, which are then posted on this website and distributed to the NSCAC membership to share with Advisory Committees/Councils and state associations.

Please return questions via an emailto NSCAC Operations, Rose Schafhauser, email: schafhause@aol.com, by close of business Friday, March 9. No late questions will be accepted.

The next NSCAC meetings will be held at Medtrade in Las Vegas, tentatively scheduled the afternoon of Wednesday, April 11 (we are working on 12:30 - 3:30 for both the NSCAC only and NSCAC with the NSC - confirmation of date and time will be forthcoming).

PLEASE SUBMIT QUESTION (S) BY AREA:

PECOS:

Site Visits/Overland Solutions:

Licensure:

CMS 855 Enrollments/Re-validations:

NSC Customer Service:

NSC Education:

NSC Website:

Other:

Please indicate if attachments/examples/supporting information is attached:

Submitted by: Please provide name, company, phone and email address:

Rose Schafhauser

NSCAC Operations 

10480 Perkins Ave N

Stillwater, MN 55082

email: schafhause@aol.com, website: www.nscac.org

ph: 651-351-5395