(Medicare Claims Processing Manual)

MSN Crossover Messages   Effective with the October 2004 systems release, the A/ B MACs and DME MACs began to receive BOI reply trailers (29) that contain an MSN indicator Y (Print trading partner name on MSN) or N (Do not print trading partner name on MSN).  When a COBA trading partner is in full production (Test/Production Indicator=P), the A/ B MAC  and DME MAC shall read the MSN indicator returned on the BOI reply trailer (29).  If the A/B MAC or DME MAC receives an MSN indicator N, it shall print its generic crossover message(s) on the MSN rather than including the trading partners name.  Examples of exi sting generic MSN messages include the following:    (For all COBA ID ranges other than Medigap)   MSN #35.1 -  This information is being sent to private insurer(s).  Send any questions regarding your benefits to them.    (For the Medigap COBA ID range)   MSN #35.2 -  We have sent your claim to your Medigap insurer.  Send any questions regarding your Medigap benefits to them.   Beginning with the October 2004 systems release, A/B MACs and DME MACs shall follow these procedures when determining whether to update  its claims history to show that a beneficiarys claim was selected by CWF to be crossed over.    If the A/B MAC or DME MAC receives a BOI reply trailer (29) that contains a Test/Production Indicator T, it shall not update its claims history to show that a  beneficiarys claim was selected by CWF to be crossed over.    If the A/B MAC or DME MAC receives a BOI reply trailer (29) that contains a Test/Production Indicator P, it shall update its claims history to show that a beneficiarys claim was selected by C WF to be crossed over.    Effective January 5, 2009, when CWF returns a BOI reply trailer (29) to an A/B MAC and DME MAC that contains only a COBA ID in the range 89000 through 89999, the A/B MAC and DME MAC shared system shall suppress all crossover information, including name of insurer and generic message#35.1, from all beneficiary MSNs.   A/B MACs and DME MACs shall not update their claims histories to reflect transference of tagged claims with COBA ID range 89000 through 89999 to the B CRC.   ASC X12 835 (Electronic Remittance Advice)/ Provider Remittance Advice Crossover Messages   Beginning with the October 2004 release, when CWF returns a BOI reply trailer (29) that contains a T Test/Production Indicator to the A/B MACs and DME MACs, they shall not print information received from the BOI reply trailer (29) in the required crossover fields on the ASC X12 835 Electronic Remittance Advice or other provider remittance advices that are in production.  Beginning with the October 2004 release, when CWF returns a BOI reply trailer (29) that contains a P Test/Production Indicator to the A/B MACs and DME MACs, they shall use the returned BOI trailer information to take the following actions on the providers 835 Electronic Remittance Advice:   a. Input code 19 in CLP -02 (Claim Status Code) in Loop 2100 (Claim Payment Information) of the 835 ERA (v. 4010- A1). [ NOTE:  R ecord 20 in CLP -02 (Claim Status Code) in Loop 2100 (Claim Payment Information) when Medicare is the secondary payer.]   b. Update the 2100 Loop (Crossover Contractor Name) on the 835 ERA as follows:    NM101 [Entity Identifier Code] Use TT, as specified in the 835 Implementation Guide.    NM102 [Entity Type Qualifier] Use 2, as specified in the 835 Implementation Guide.    NM103 [Name, Last or Organization Name] Use the COBA trading partners name that accompanies the first sorted COBA ID returned to you on the BOI reply trailer.   NM108 [Identification Code Qualifier] Use PI (Payer Identification)    NM109 [Identification Code] Use the first COBA ID returned to you on the BOI reply trailer.  (See line 24 of the BOI aux. file record   Effective with January 5, 2009, if CWF returns only COBA ID range 89000 through 89999 on a BOI reply trailer (29) to an A/B MAC and DME MAC, the assoc iated shared  system shall suppress all crossover information (the entire 2100 loop) on the 835 ERA.   CWF Sort Routine for Multiple COBA IDs   Effective with October 3, 2011, when a beneficiarys claim is associated with more than one COBA ID (i.e., the beneficiary has more than one health insurer/benefit plan that pays after Medicare), CWF shall sort the COBA IDs and trading partner names in the following order on the returned BOI reply trailer (29): 1) Eligibility -based Medigap (30000- 54999); 2) Medigap claim -based (55000- 59999); 3) Supplemental (00001- 29999); 4) Other Insurer (80000- 80213); 5) Other Insurance (80215- 88999); 6) TRICARE (60000- 69999); 7) CHAMPVA (80124); 8) Medicaid (70000 -79999); and 9) Other -Health Care Pre- payment Plan [HCPP] (89000- 89999).  When two or more COBA IDs fall in the same range (see element 24 of the Data Elements Required for the BOI Aux File Record Table in chapter 27, 80.4 for more details), CWF shall sort numerically within the same range.   IV. A/B MAC and DME MAC Act ions Relating to the Transition to the ASC X12 837 Version 5010 and NCPDP Version D.O   A.  CWF COIF and BOI Reply Trailer (29) Processes   Effective January 5, 2009, the BCRC , at CMSs direction, created a new 1- byte 5010 Test/Production Indicator and a new 1 -byte NCPDP D.0 Test/Production Indicator on the COBA Insurance File [COIF] (valid values= Nnot applicable or not ready as yet; T test; P production).  In addition, the CWF maintainer shall add a new 5010 Test/Production Indicator and an N CPDP D.0 Test/Production Indicator to the BOI reply trailer (29) format.  (See Pub.100- 04 chapter 27, 80.7 for additional details regarding CWF requirements relating to the new crossover claim formats.)   B.  Transmission of the COB Flat File or NCPDP File to the BCRC   Regardless of whether a COBA trading partner is in test mode (Test/Production Indicator returned via the BOI reply trailer 29=T) or production mode (Test/Production Indicator returned via the BOI reply trailer 29=P), A/B MACs and DME MACs sh all transmit all non -NCPDP claims received with a COBA ID via a BOI reply trailer to the BCRC in an ASC X12 837 flat file, as described in Transmittal AB -03-060.  In a separate transmission, DME MACs shall send the claims received in the NCPDP file format to the BCRC.  A/B MACs and DME MACs shall enter the 5 -digit COBA ID picked up from the BOI reply trailer (29) in the 1000B loop of the NM1 segment in the NM109 field.  In a situation where multiple COBA IDs are received for a claim, A/B MACs and DME MACs s hall send a separate ASC X12 837 or NCPDP transaction to the BCRC for each COBA ID.  A/B MACs and DME MACs shall perform the transmission at the end of their regular batch cycle, when claims are removed from their payment floor, to ensure crossover claims are not processed by the COBA trading partner prior to Medicares final payment.  Transmission to the BCRC shall occur via Connect: Direct or other CMS dictated connectivity.    Effective with October 4, 2005, when the A/B MAC and DME MAC shared systems tra nsfer processed claims to the BCRC as part of the COBA process, they shall include an additional 1 -digit alpha character (T=test or P=production) as part of the BHT03 identifier (Beginning of the Hierarchical Transaction Reference Identification) that is included within the ASC X12 837 flat file or NCPDP submissions.  The shared systems shall determine that a COBA trading partner is in test or production mode by referring to the BOI reply trailer (29) originally received from CWF for the processed claim . (See 70.6.1 of this chapter for further details about the BHT03 identifier.)  Effective October 2, 2006, the Virtual Data Center (VDC), formerly the Enterprise Data Centers (EDCs), shall transmit a combined COBA test and production ASC X12 837 flat file and a combined test and production NCPDP file, as applicable, to the BCRC.  NOTE :  This requirement changes the direction previously provided in October 2005 through the issuance of Transmittal 586.  Flat File Conventions for Transmission to the B CRC For Production COBA Crossover Claims Prior to July 2012  With respect to ASC X12 837 COB flat file submissions to the BCRC, A/B MACs (Part  B) and DME MACs shall observe these process rules:   The following segments shall not be passed to the BCRC:  1. ISA (Interchange Control Header Segment);  2. IEA (Interchange Control Trailer Segment);   3. GS (Functional Group Header Segment); and  4. GE (Functional Group Trailer Segment).  The 1000B loop of the NM1 segment denotes the crossover partner.  If multiple COBA IDs are received via the BOI reply trailer, the shared system shall ensure that a separate ASC X12 837 transaction should be submitted for each COBA ID received.  As the crossover partner information will be unknown to the standard systems, the following fields should be formatted as indicated for the NM1 segment:  NM103Use spaces; and  NM109Include COBA ID (5 -digit COBA ID picked up from the BOI reply trailer 29).  The 2010BA loop denotes the subscriber information.  If available, the subscriber name, address, and policy number should be used to complete the NM1, N3, and N4 segments.  If unknown, the segments should be formatted as follows, with BCRC completing any missing information:  NM1 segmentFor NM103, NM104, NM105, and NM107, use spaces; NM1 segment For NM109, include beneficiarys Medicare beneficiary identifier ; N3 segmentUse all spaces; and  N4 segmentUse all spaces.   The 2010BB loop denotes the payer name.  Per the HIPAA Implementation Guide (IG), this loop should define the secondary payer when sending the claim to the second destination payer.  Consequently, given that the payer related to the COBA ID will be unknown by the standard systems, the NM1, N3, and N4 segments should be formatted as follows, with BCRC completing any missing information:   NM1 segment For NM103, use spaces;  NM1 segment For NM109, include the COBA ID (5- digit COBA ID picked up from the BOI reply trailer 29);  N3 segment Use all spaces; and  N4 segment Use all spaces.   The 2330B loop denotes other payers for the claim.  If multiple COBA IDs are returned via the BOI reply trailer, payer information for the additional COBA IDs will be unknown.  As with the 2010BB loop, the NM1 segment should be formatted as follows, with BCRC completing any missing informati on:  NM103Use spaces; and  NM109Include COBA ID (5 -digit COBA ID picked up from the BOI reply trailer 29).   The 2330B loop shall be repeated to allow for the inclusion of the name (NM103) and associated Trading Partner ID (NM109) for each existing trading partner.   The 2320 loop denotes other subscriber information.  Within the SBR segment, the SBR03 and SBR04 segments are used to define the group/policy number and insured group name, respectively.  If the information is available for these fields, those values should be propagated accordingly for both current trading partners and COBA trading partners.  The BCRC will inspect these values for COBA related eligibility based claims and overlay as appropriate.  Spaces should only be used for COBA -related situa tions.   SBR01 Treat as normally do.  With respect to ASC X12 837 COB flat file submissions to the BCRC, A/B MACs (Part A) and A/B MACs (Part HHH) shall observe these process rules: