(Medicare Claims Processing Manual Crosswalk)

30.3.12 B3-17001 Carrier Annual Participation Program 1 30.3.12.1 B3-17001.1 Carrier Pa rticipation and Billing Limitations 1 30.3.12.2  B3-17001.1   Carrier Participation Agreement Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1 30.3.12.3  B3-17002   Carrier Rules for Limiting Charge 1                                          40 A3-3008,A2-2800    Termination of Provider Agreement 1 40.1 A3-3008.1,A2-2800.1 RHC-330,OPT-124   Voluntary Termination 1 40.1.1 A2-2800.2   RHC-330 Close of Business 1 40.1.2 HHA-145,HO-145;  SNF-145;  RHC-331,  RHC-332 Change of Ownership 1 40.1.3  A3-3008.3 Expiration and Renewa l-Nonrenewal of SNF Term Agreements 1 40.2 A3-3008.2 RHC-331 Involuntary Terminations1 40.2.1  A2-2800.3 Processing Involuntary Terminations1 40.2.2 A2-2801,A2-2801.1    Intermediary Report on Provider Deficiencies 1 40.2.2.1 A2-2801.2    Subsequent Communications With Provider 1 40.3 A2-2804    Readmission to Medicare Program After Involuntary Termination 1 40.3.1 A2-2804.1    Effective Date of Provider Agreement 1 40.3.2 A2-2805 RHC-334 Fiscal Considera tions In Provider Readmission To Medicare Program After Involuntary Termination Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1 40.4 A3-3008.4    Payment for Services Furn ished After Termination, Expiration, or Cancellation of Provider Agreement 1 40.4.1  A3-3600.3            Reviewing Inpatient  Bills for Services After Suspension, Termination, Expiration, or Cancellation of Provider Agreement, or After a SNF is Denied Payment for New Admissions 1 40.4.2  A3-3699.3.C Status of Hospital or SNF After Termination, Expiration, or Cancellation of Its Agreement 1 40.5 A3-3600.7    Intermediary/Carrier/DMERC Responsibilities for Informing Providers of Changes 1 50 A3-3301    Filing a Request for Payment With the Carrier or Intermediary 1 50.1 A3-3302    Request for Payment from the Carrier or Intermediary 1 50.1.1 A3-3302.1,A3-3602.4     Billing Form as Request for Payment 1 50.1.2 A3-3302.2    Beneficiary Request for Payment on Provider Record - UB-92 and Electronic Billing (Part A and Part B) 1 50.1.3 A3-3302.5 B3-3008   Signature on the Request for Payment by Someone Other Than the Patient 1 50.1.4 A3-3302.6    Request for Payment as a Claim for HI Entitlement 1 50.1.5 A3-3302.7    Refusal by Patient to Request Payment Under the Program 1 50.1.6  B3-3057   When Beneficiary Statement is Not Required for Physician/Supplier Claim Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1                                 50.1.7 A3-3305.1,A3-3312.2,   B3-3004,  B3-3000 partial   Definition of a Claim for Payment 1 50.1.8 A3-3305.2,A3-3305.3     Establishing Date of Filing - Postmark Date Carriers 1 50.2 A3-3603 Frequenc y of Billing for Providers 1 50.2.1     Inpatient Billing from Hospitals and SNFs 1 50.2.2     Frequency of Billing for Outpatient and Services to Intermediaries 1 50.2.3 A3-3603.1    Submitting Bills In Seque nce Ffor a Continuous Inpatient Stay or Outpatient Course of Treatment 1 A3-3603.2,Definition of spell of illness from MIM-3035    Reprocess Inpatient or Hospice Claims in Sequence 1 60    No Pay Bills 1 70 A3-3600.2    Time Limitations for Filing Provider Claims 1 70.1 A3-3600.2A Determining Start Date of Timely Filing Period--Service Date 1 70.2 A3-3600.2B Definition of Claim1 70.2.1  A3-3600.2B1 Appropriate Medicare Contractor1 70.2.2 A3-3600.2B2    Form Prescribed by CMS Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1 70.2.3 A3-3600.2B3    In Accordance with CMS Instructions 1                                          70.2.3.1 A3-3600.2B3a    Incomplete or Invalid Submissions 1 70.2.3.2 A3-3600.2B3b    Handling Incomplete or Invalid Submissions 1 A3-3600.2B3c 1 70.3 A3-3600.2C Determining End Date  of Timely Filing PeriodReceipt Date 1 1 70.4 A3-3600.2D Determination of Timely Filing and Resulting Actions 1 70.4.1     Part A Institutional Provider Services and Part A and Part B Home Health Services 1 70.5 A3-3600.2E    Application to Special Claim Types 1 70.6 A3-3600.2F    Filing Claim Where Usual Time Limit Has Expired 1 70.7 A3-3600.2G    Exceptions Allowing Extension of Time Limit 1 70.7.1  A3-3600.2G1 Administrative Error1 70.7.2  A3-3600.2G2 Statement of Intent1 70.7.3  A3-3600.2G3 Reopening of Determinations Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1                      80 A3-3600,A3-3600.1 B3-13306, B2-5240.11 HO-401,HO-401A,  HH-462  Carrier and Intermediary Claims Processing Timeliness 1 80.1     Control and Counting Claims 1 80.2 A3-3600.1 B2-5240.11A  HO-401D Definition of Clean Claim 1 80.2.1 A3-3600.1-Item 7 Receipt Date1 80.2.1.1 A3-3600.1A.1 B2-5240.11D   Payment Ceiling Standards 1 80.2.1.2 A3-3600.1   HO-401B Payment Floor Standards 1 80.2.2 A3-3600.1-Item 5   HO-401C Interest Payment on Clean Non-PIP Claims Not Paid Timely 1 80.2.2.1  B2-5240.11C   Determining and Paying Interest 1 80.2.2.2     Preparation of IRS Form 1099-INT 1 80.3 A3-3600.1-Item 4 B2-5240.11B  HO-401E Other Claims (Other Than Clean) 1 80.3.1 A3-3605.1 B3-3005.1   Incomplete or Invalid Claims Processing Terminology 1 80.3.2 A3-3605.2 B3-3005.2B   Handling Incomplete or Invalid Claims 1 80.3.2.1 A3 3605.3 B3-3005.3,   Data Element Requirements Matrix Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1                                       80.3.2.1.1  B3-3005.4,R1813B3   Carrier Data Element Requirements 1 80.3.2.1.2  B3-3005.4,R1813B3   Conditional Data Element Requirements for Carriers and DMERCs 1 80.3.2.1.3     Carrier Specific Requirements for Certain Specialties/Services 1 80.3.2.2  A3-3606 Intermediary Consistency Edits1 80.4 A3-3676    Enforcement of Provider Billing Timelines and Accuracy Standard to Continue PIP (Periodic Interim Payment) 1 80.5     Do Not Forward Initiative (DNF) 1 80.5.1  B3-4021,  B-02-023  Carrier DNF Requirements 1 80.5.1.1   B-02-11  Reporting Requirements - Carriers 1 80.5.2 A-02-12 Intermediary DNF Requirements1 80.5.2.1     Reporting Requirements - Intermediaries 1 90 HO-408,HH-412 Patient Is a Member of an M+CO for Only a Portion of the Billing Period 1 100 HO-301,HO-469,  42 CFR 411.32 Medicare as a Secondary Payer 1 110 HO-413,HH-480,  SNF 545 Provider Retention of Health Insurance Records Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1                    110.1 HO-413,HH-480,  SNF 545.1 Categories of Health Insuran ce Records to Be Retained 1 110.2    SNF 545.3,  HO-413,  HH-480 Microfilming Records 1 110.3  Retention Period1 110.4 HO-413.1,HH-480.1,  SNF 545.4 Destruction of Records 1 130 A3-3670  AB-00-38  Detection of Duplicate Claims 1   B3-3999   Exhibit 1 - Data Element Requirements Matrix (Carrier)