(Medicare Claims Processing Manual Crosswalk)

Medicare Claims Processing Manual Chapter 1 - General Billing Requirements Crosswalk Chap                                Sect Int.Pub. 13 Carrier Pub. 14 PMs Other Description1 01 Foreword1 10 Jurisdiction for Claims1 10.1  B3-3100   Carrier Jurisdiction of Requests for Payment 1 10.1.1 B3-3100.1,B3-3101,  B4-2010 partial,  B3-4267, R1813B3   Area Carrier Physician's Services 1 10.1.2     Physician, Supplier, and Group Practice Billing for Multiple Locations 1 10.1.3 B3-3100.6,R1813B3   Exceptions to Provider Billing Local Carrier 1 10.1.4  B3-2312   Services Received by Medicare Beneficiaries Outside the United States 1 10.1.4.1 B3-2312-   2312.2   Physician and Ambulance Services Furnished in Connection With Covered Foreign Inpatient Hospital Services Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1 10.1.4.2  B3-2312.3   Carriers Designated to Process Foreign Claims 1 10.1.4.3  B3-2312.4   Source of Part B Claims 1 10.1.4.4  B3-2312.5   Medicare Approved Ch arges for Services Rendered in Canada or Mexico 1 10.1.4.5  B3-2312.6   Appeals of Denied Charges for Physicians and Ambulance Services in Connection With Foreign Hospitalization 1 10.1.4.6  B3-2312.7   Claims for Services Furnished in Canada and Mexico to Qualified Railroad Retirement Beneficiaries 1 10.1.4.7  B3-2020.1   Shipboard Services Billed to the Carrier 1           10.1.5 B3-3102,B3-3116   Domestic Claims Processing Jurisdictions 1 10.1.5.1  B3-3116   Suppliers of Durable Me dical Equipment, Prosthetics, Orthotics, Supplies, Parental and Enteral Nutrition (PEN) 1 10.1.5.2     Supplier of Portable X-Ray, EKG or Similar Portable Services 1 10.1.5.3     Ambulance Services Submitted to Carriers 1 10.1.5.4 Independent Laboratories1 10.1.5.4.1     Cases Involving Referral Laboratory Services 1 10.1.6  B3-3103   Railroad Retirement Beneficiary Carrier Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1          10.1.7 B3-3104,B3-3060 for buy-in definition Welfare Carriers1 10.1.8  B3-3105   United Mine Workers of America (UMWA) 1 10.1.9  B3-3110   Disposition of Misdirected Claims 1 10.1.9.1     Area Carrier to Another Area Carrier 1 10.1.9.2  B3-3110   Area Carrier to RRB-Named Carrier 1 10.1.9.3     RRB-Named Carrier to Area Carrier 1 10.1.9.4     Area Carrier or RRB-Named Carrier to Welfare Carrier 1 10.1.9.5     Protests Concerning Transfer of Requests for Payment to Carrier or Intermediary 1 10.1.9.6  B3-3110.1   Transfer of Claims Material Between Carrier and Intermediary 1 10.1.9.6.1  B3-3110.2   Signature Requirements for Carriers and Intermediaries 1 10.2     Intermediary Jurisdiction of Requests for Payment 1 10.2.1     Intermediary Payment for Emergency and Foreign Hospital Services 1 10.3  B3-3115   Payments Under Part B for Services Furnished by Suppliers of Services to Patients of a Provider 1 20 A2-2807.A,   A33600 4  OPT-122 Provider Election of Intermediary Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description A3-3600.4 1 20.1 A2-2807.B    Intermediary Service to HHAs and Hospices 1 20.2 A2-2807.C    Provider Change of Ownership (CHOW) 1 20.3 A2-2807.D    Multi-State Provider Chains Billing Intermediaries 1 20.4 A2.2808    The Process for a Provider to Change an Intermediary 1 20.5                     A2.2809 Intermediary Relationshi ps With Providers Serviced by Another Intermediary 1 20.5.1     Solicitation of a Provider to Secure a Change of Intermediary 1 20.5.2 Communications1 30 A2-2810 Provider Participation1 30.1 A2-2840,    RHC-320 Content and Term s of Provider Participation Agreements 1 30.1.1    RHC-321 Provider Charges to Beneficiaries 1 30.1.2    RHC-322 Provider Refunds to Beneficiaries 1 30.1.3    RHC-323 Provider Treatment of Beneficiaries 1 30.2 A3-3488,A3- 3703.1 B3-3060   Assignment of Provider's Right to Payment 1 30.2.1     Exceptions to Assignment of Provider's Right to Payment - Claims Submitted to FIs and Carriers 1 30.2.2  B3-3045.1   Background and Purpose of Reassignment Rules - Claims Subm itted toCarriersChap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description Submitted to Carriers 1 30.2.2.1 A3-3005    Reassignments by Nonphysician Suppliers - Claims Submitted to FIs 1 30.2.3     Effect of Payment to Ineligible Recipient 1 30.2.4 A3-3488.1 B3-3060.10   Payment to Agent - Claims Submitted to Carriers 1 30.2.5 A3-3488.2 B3-3060.11   Payment to Bank 1 30.2.6  B3-3060.1   Payment to Employer of Physician - Carrier Claims Only - Carrier Claims Only 1 30.2.7  B3-3060.2   Payment to Facility in Which Services Are Performed 1 30.2.8  B3-3060.3   Carrier Payment to Health Care Delivery System - Claims Submitted to Carriers 1 30.2.8.1  B3-3060.3C   Definition of Health Care Delivery System 1 30.2.8.2  B3-3060.3D   University-Affiliated Medical Faculty Practice Plans - Claims Submitted to Carriers 1        30.2.8.3 B3-3060.3E,B3-7065   Managed Care Organization, including HCPPs, Cost-Contracting HMOs, CMPs, and Medicare + Choice Organizations - Claims Submitted to Carriers 1 30.2.9 B3-3060.4,R1813B3   Payment to Physician for Purchased Diagnostic Tests - Claims Submitted to Carriers 1 30.2.9.1  B3-3060.5   Payment to Supplier of Diagnostic Tests for Purchased Interpretations Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1 30.2.10  B3-3060.6   Payment Under Reciprocal Billing Arrangements - Claims Submitted to Carriers 1 30.2.11  B3-3060.7   Payment Under Locu m Tenens Arrangements - Claims Submitted to Carriers 1                                 30.2.12 B3-3060.8 Establishing That a Person or Entity Qualifies to Receive Payment on Basis of Reassignment - for Carrier Processed Claims 1 30.2.13  B3-3060.9   Billing Procedures for Entities Qualified to Receive Payment on Basis of Reassignment - for Carrier Processed Claims 1 30.2.14 A3-3488.3 B3-3060.6E.B3-3060.12   Correcting Unacceptable Payment Arrangements 1 30.2.14.1 Questionable Payment Arrangements1 30.2.15 A3-3488.4 B3-3060.13,B3-3060.14   Sanctions for Prohibited Payment Arrangement 1 30.2.16 A3-3488.5 B3-3060.15,B3-7065 partial   Prohibition of Assignments by Beneficiaries 1 30.3 A3-3005 B3-17000 Physician/Practitione r/Supplier Participation Agreement and Assignment - Carrier Claims 1 30.3.1  B3-3040.4   Mandatory Assignment on Carrier Claims 1 30.3.1.1  B-3040.3   Processing Claims for Services of Participating Physicians or Suppliers by Carriers 1 30.3.2  B3-3045.1   Nature and Effect of Assignment on Carrier Claims Chap Sect Int. Pub. 13 Carrier Pub. 14 PMs Other Description 1 30.3.3  B3-3045.2   Physician's Right to Collect from Enrollee on Assigned Claim Submitted to Carriers 1 30.3.4  B3-3045.3   Effect of Assignment Upon Rental or Purchase of Durable Medical Equipment on Claims Submitted to Carriers 1 30.3.5  B3-3045.4   Effect of Assignment Upon Purchase of Cataract Glasses from Participating Physician or Supplier on Claims Submitted to Carriers 1 30.3.6  B3-3045.5   Mandatory Assignment Requirement for Physician Office Laboratories on Claims Submitted to Carriers 1 30.3.7  B3-3045.6   Physicians Billing fo r Purchased Diagnostic Tests (Other Than Clinical Diagnostic Laboratory Tests) on Claims Submitted to Carriers 1 30.3.8  B3-3045.7   Mandatory Assignment and Other Requirements for Home Dialysis Supplies and Equipment Paid Under Method II on Claims Submitted to Carriers 1 30.3.9  B3-3040   Filing Claims to a Carrier For Nonassigned Services 1 30.3.10  B3-3040.1   Carrier Submitted Bills by Beneficiary 1 30.3.11  B3-3040.2   Carrier Receipted Bill - Definition 1            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