(Medicare Claims Processing Manual)

80.5 - Do Not Forward Initiative (DNF)  (Rev. 1, 10- 01-03)  80.5.1 - Carrier DNF Requirements  (Rev. 1, 10- 01-03) B3-4021, B -02-023 This initiative entails the use of Return Service Requested envelopes to preclude the forwarding of Medicare checks to locations other than those recorded on the Medicare provider files.  The use of these envelopes permit the U.S. Postal Service to retur n Medicare checks to local carriers and durable medical equipment regional carriers (DMERCs) free of charge, as the postal service has done for the DMERCs since February 1997. A.  Returned Check Process for Carriers and DMERCs  The CMS requires carriers and DMERCs to use Return Service Requested envelopes for all checks they mail to providers and suppliers.  In addition, carriers and DMERCs must use return service requested envelopes for hardcopy remittance advices, with respect to providers that have elected to receive hardcopy remittance advices. They do not use return service requested envelopes for beneficiary correspondence, such as Explanations of Benefits (EOB) or Medicare Summary Notices (MSNs), or for overpayment de mand letters.  Carriers and DMERCs must be in compliance with postal regulations when developing their DNF envelopes.  Carriers and DMERCs must sort outgoing mail to identify provider or supplier checks, and must only place these checks in Return Service Requested enve lopes.  The postal service will forward remittance advice without checks and checks to beneficiaries.  When the check is returned, if applicable, the postal service will provide the carrier or DMERC with a new address or reason for nondelivery.  If the postal service supplies a carrier or DMERC with a new address for the provider or supplier with the returned check or remittance, do not automatically change the address of the provider or supplier or re-mail the check/remittance.  (See the change of address process described below.)  Once the post office returns an envelope, record the check number and any correspondence in the envelope, using normal procedures for incoming mail.  For example, microfiche, and photocopy the mail.  Contractors must also log and account for the checks, noting pertinent information, such as the provider or suppliers name and number, date of the check, the check number, the amount of the check, and the date the check was returned.  The carriers or DMERCs financial staff must either reissue the check based upon receipt of an updated, verified address, or systematically cancel the returned check and notify the provider enrollment staff that a provider must be flagged DNF.  The provider enrollment staff must annotate the provider or suppliers file with a DNF flag, pending receipt of a verified address.  Carriers and DMERCs must process any subsequent claims a flagged provider or supplier submits through the Common Working File (CWF) t o completion, but must not generate any additional check or checks for that provider or supplier until an authorized address correction is received and the flag removed. In addition, provider enrollment staff must alert the benefit integrity staff in the event that any investigations are currently taking place, which are affiliated with flagged providers or suppliers.  DMERCs must notify the National Supplier Clearing Hous e (NSC).  All carriers must implement a standardized reporting format for this process.  NOTE:  Because some providers get paid through electronic funds transfer (EFT), there may be cases where a provider does not have a correct address on file, but the contractor continues to pay the provider through EFT.  This instruction applies to providers receiving paper.  B.  Change of Address Process for Local Carriers and DMERCs  When a flagged provider or supplier notifies you that they have not received their checks, direct them to your provider enrollment staff.  The provider or supplier must complete a change of address Form CMS -855C, or other written notification.  The form or  written notification must bear an original signature from an authorized representative of the entity that completed the original registration form.  No copies, faxes, or stamps are acceptable.  For purposes of this process, the most important address is t he Pay To address.  If the provider or supplier did not furnish the Pay To address on Form CMS -855C, or other written notification, return it to the provider or supplier. The provider or supplier must furnish the Pay To address.  Addresses may not be  changed based on telephone calls.  Although the Pay to Address is the most critical, CMS requires corrections to all addresses before the contractor can remove the DNF flag and begin paying the provider or supplier again.  Therefore, carriers may not release any payments to DNF providers until the provider enrollment area or the NSC has verified and updated all addresses for that providers location When a provider enrollment staff member verifies an address, the provider must update the address for the provider or supplier and remove the DNF flag.  Provider enrollment staff must send a daily report to financial staff, advising which providers and suppliers are no longer flagged DNF.  Financial staff must generate all payment that is due the provider or supplier for claims that were adjudicated for the time period the provider or supplier was flagged.  C.  Educational Requirements  1.   Contractors must publish the requirement that providers must notify the Part B carrier or NSC of any changes of address, both on their Web sites and in their next regularly scheduled bulletins. 2.   Contractors must continue to remind suppliers and providers of this requirement in their bulletins at least yearly thereafter.   80.5.1.1 - Reporting Requirements - Carriers  (Rev. 2228, Issued: 05- 20-11, Effective:06 -06-11, Implementation:06- 06-11)  A. Field Definitions for DNF Spreadsheet   To be certain that all parties understand what information CMS needs to get from these reports, the following definitions have been created for each field. No rolling or annual totals should be included.  Suppliers/Providers Flagged/Corrected Counts Field #  Definition  1  New Flags: the number of all suppliers or providers the contractor flagged for DNF during the reporting quarter (regardless of whether or not they still have a flag, and regardless of whether the contractor flagged them due to a returned check or returned remittance advice), that were not flagged at the end of the previous reporting quarter.  2  Removed Flags: the number of all suppliers or providers who supplied a verified, correct address, causing the contractor to remove the DNF flag, during the reporting quarter.  3  Total Flags: the total number of all suppliers or providers who still have a DNF flag on the last day of the reporting quarter, regardless of whether the contractor flagged them due to a returned check or returned remittance advice), including those the contractor flagged in a previous quarter who did not supply a verified, corrected address.   Check Counts Field #  Definition  4  Returned Checks: the total number of checks the post office returned to the contractor due to an incorrect address during the reporting quarter, regardless of whether or not the supplier provided a corrected address and may have been reissued the check dur ing the quarter.  5  Held Checks: the total number of all checks that contractors did not issue due to DNF flags in the system during the reporting quarter, regardless of whether or not the supplier provided a corrected address and was later paid.  6  Reissued and Released Checks: the total number of all checks (both those the post office returned, and those the contractor had been holding due to a DNF flag in the system) the contractors reissued or released during the reporting quarter, to suppliers or  providers who submitted a verified, correct address.   Dollar Counts Field #  Definition  7  Amount Returned: the total dollar amount of all checks the post office returned due to an incorrect address during the reporting quarter, that you are still holding at the end of the reporting quarter.  8  Amount Held: the total dollar amount of all checks the contractors did not issue due to DNF flags in the system during the reporting quarter, that you are still holding at the end of the reporting quarter.  9  Amount Reissued/Released: the total dollar amount of all payments (both those the post office returned, and those the contractor had been holding due to a DNF flag in the system) the contractors reissued during the reporting quarter, to suppliers or providers who submitted a verified, correct address.  10  Net Amount: the value in field 7 plus the value in field 8, minus the value in field 9 - it is possible that this number will be a negative figure.   NOTE A   If a contractor flags a provider or supplier for DNF more than one time within a quarter, only count that supplier or provider once for fields 1, 2, and 3.  NOTE B   Multi- Carrier Systems contractors may use a claim count for items 4 -6, 8, and 9, rather than a check count.   B. Systems Requirements   Carriers and DMERCs generate reports out of the shared systems and must be able to generate figures for each field in accordance with the above descriptions.   Furthermore, shared systems must be certain that when the system calculates the totals, it includes the first returned check that prompted the DNF flag. The shared systems should program the reports so that the contractors may request monthly detail report s to verify the quarterly totals. However, carriers only send the quarterly reports to CMS central office (CO) and regional office (RO), not the monthly reports.   C. Quarterly Reporting Requirements   All contractors must submit their DNF reports by the fifteenth day of each month that follows the end of a quarter (i.e., January 15, April 15, July 15, and October 15). The instructions for the current process are defined in Section F, Deliverable Schedul e, of each individual contract.  Contractors (A/B MACs and DME MACs) must submit their DNF reports to CMS Automated Reporting Tracking System (CMS ARTs).  Legacy Contractors (Carriers) must submit their DNF reports to their appropriate CMS Central Office contact .  D. Other Requirements   Contractors must continue to follow all other aspects of the DNF reporting initiative (e.g., use of Return Service Requested envelopes, assignment of a DNF flag to appropriate providers/suppliers) as instructed in the 80.5.   E.  Examples - Blank Report  DO NOT FORWARD PROJECT  Activity for the _____ Quarter of FY _____  $$ Region  Medicare Contractor      Suppliers/Providers Flagged/Correct Counts     1.     # new supplier/providers flagged during the reporting quarter     2.     # suppliers/providers whose flags were removed, end of the reporting quarter     3.     # suppliers/providers flagged, end of the reporting quarter         Check Counts     4.     # new checks returned during the reporting quarter     5.     # of checks held during the reporting quarter     6.     # checks reissued during the reporting quarter         Dollar Counts     7.     $ amount of new checks returned during the reporting quarter     8.     $ amount of checks held during the reporting quarter     9.     $ amount reissued during the reporting quarter     10.   $ amount returned to trust fund during the reporting quarter         Report By: ____________________________________     Report Date: __________________________________     Sample Completed Report  SAMPLE - DO NOT FORWARD PROJECT  Activity for the 3RD  Quarter of FY 2003  $$ Region  Medicare Contractor    Q XYZ Contractor  Suppliers/Providers Flagged/Correct Counts     1.     # new supplier/providers flagged during the reporting quarter  125   2.     # suppliers/providers whose flags were removed, end of the reporting quarter  30   3.     # suppliers/providers flagged, end of the reporting quarter  117       Check Counts     4.     # new checks returned during the reporting quarter  40   5.     # of checks held during the reporting quarter  100   6.     # checks reissued during the reporting quarter  60       Dollar Counts     7.     $ amount  of new checks returned during the reporting quarter  100,000    8.     $ amount of checks held during the reporting quarter  600,000    9.     $ amount reissued during the reporting quarter  500,000    10.   $ amount returned to trust fund during the reporting quarter  200,000        Report By:     ___Jane Doe______________________     Report Date:  __April 02, 2003___________________       80.6  Processing All Diagnosis Codes Reported on Claims Submitted to Carriers  (Rev.735, Issued: 10-31- 05, Effective: 04 -01-06, Implementation: 04-03-06) Carrier standard systems shall capture and process all diagnosis codes reported on a claim (both paper and electronic) up to the maximum permitted under the format.  The CWF shall process and maintain all diagnosis codes reported to CWF on a carrier processed claim.   90 - Patient Is a Member of a Medicare Advantage (MA) Organization for Only a Portion of the Billing Period  (Rev. 11731, Issued: 12-09-22, Effective: 01-11-23, Implementation: 01-11-23)