(Current law permits the VA to collect appropriate Medicare coinsurance and deductible amounts from supplemental insurers for claims for supplies and services ordinarily covered by Medicare but furnished:)

The VA auxiliary file within CWF also provides a claims history for VA Part B equivalent claims.  The auxiliary contains the information about VA claims necessary to show Medicare- equivalent Part B deductibles s atisfied by the VA claims.  National Claims History is not updated with the VA deductible information, and these changes have no effect on Medicare claims.  CWF sends the Part B deductible information to the A/B MACs (A) and (B) for this project.  This aff ects claims with dates of service of January 1, 2004, and after and will use deductible amounts for calendar years 2004 and after.  1.3 - Generating Unsolicited Responses to the VA  (Rev. 1454, Issued: 02- 22-08, Effective: 04 -01-08, Implementation: 04- 07-08)  While the VA is entitled by law to collect the coinsurance and deductible amounts that would have been payable had the claim been a true Medicare claim, it is generally permitted to do so only to the extent that there are no true Medicare claims for coinsurance and deductible submitted to the insurer for the same beneficiary for the same year.  While the VA submits these Medicare -equivalent claims in good faith, based on the current deductible information within CWF and maintained by the shared systems, situations sometimes arise where a true Medicare claim is subsequently adjudicated and for whom the insurers' payment of deductible is owed.  When this occurs, and the supplemental insurer processes the true Medicare claim, it may deny the claim believing it has already paid the deductible, with the possible result of providers in turn billing the Medicare beneficiary for this amount.  While the VA is willing to pay back the amounts it collected in error, it will not always know that this situation has occu rred, and has asked Medicare to help it determine when this situation has transpired.  The solution is an unsolicited response, sent to the VA, indicating that a change in Medicare deductible has occurred since the adjudication of the VA claim.  The unsoli cited response will show the amount of deductible approved for the affected VA claim and the total true Medicare deductible satisfied as of the date the Medicare claim was adjudicated. There will be one unsolicited response per affected VA claim.  The unsolicited responses will be generated each time a Medicare claim affecting the deductible is adjudicated after the adjudication of a VA claim applying a deductible for the same year of service, even if the VA claim has not overapplied the deductible.  Although this provision became effective January 1, 2006, it affects claims with dates of service January 1, 2004, and later.   1.4 - Use of CMS Certification Numbers (CCNs) After National Provider Identifiers (NPIs) Are Fully Implemented  (Rev.  11396, Issued:05- 04-2022, Effective:10 -01-2022, Implementation:10- 03-2022)   While equivalent to Medicare claims in overall appearance and the nature of the services rendered, VA claims contain unique elements to ensure that they are processed appropriately and apart from Me dicare claims, and in particular that payment is not made.  Among these characteristics are a demo code and provider numbers which are unique to this project.   CMS has determined that it is in its best interests to have the VA continue to submit the MRA project transactions with its CMS Certification Number (CCN) instead of NPIs.   In addition, if the VA providers begin using an NPI for other purposes, Medicare -equivalent remittance advice claims must be submitted to CMS with a VA CMS Certification Number (CCN) as the provider identifier.  The demo number (31) will be assigned based on the CCN submitted and by the A/B MAC (A) or (B) number. Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R11427CP  05/20/2022  Claims Processing Man ual Update - Pub. 100.04 for Elimination of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs)  01/03/2023  12734  R11414CP  05/12/2022  Claims Processing Manual Update - Pub. 100.04 for Elimination of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs)   Rescinded and replaced by Transmittal 11427  06/13/2022  12734  R11396CP  05/04/2022  Update to  Chapters 3, 4, 27 and 37 of Publication (Pub.) 100- 04 Medicare Claims Processing Manual to Remove Reference to the Term "OSCAR"  10/03/2022  12715  R4023CP  04/20/2018  Update of Internet Only Manual (IOM), Medicare Claims Processing Manual, Publication 100- 04, Chapter 37 -  Department of Veterans Affairs (VA) Claims Adjudication Services Project   07/20/2018  10621  R3009CP  08/01/2014  Update to Pub. 100 -04, Chapter 37 to Provide Language -Only Changes for Updating ASC X12  09/02/2014  8770  R1454CP  02/22/2008  Department of Veterans Affairs (VA) Claims Adjudication Services Project -  New IOM Chapter -  Pub. 100- 04, Chapter 37 Department of Veterans Affairs (VA) Claims Adjudication Services Project  04/07/2008  5938  Back to top of chapter