Providers – Section of the CMS. Medicare enrollment information for providers , physicians, non-physician practitioners, and other suppliers. Revalidation Notice Sent List – Check to see if you have been sent a notice to revalidate your information on file with Medicare. The purpose of the COB program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare payment.
The BCRC does not process claims or claim-specific inquiries. The Medicare Administrative Contractors, (MACs), intermediaries, and carriers are responsible for processing claims submitted for primary or secondary payment and resolving situations where a provider receives a mistaken payment of Medicare benefits. This single-source development approach greatly reduces the number of duplicate MSP investigations. This also offers a centralize one-stop custo.
See full list on cms. Medicare generally uses the term Medicare Secondary Payer or MSP when the Medicare program is not responsible for paying a claim first. The BCRC uses a variety of methods and programs to identify situations in which Medicare beneficiaries have other health insurance that is primary to Medicare. For example, information submitted on a medical claim or from other sources may result in an MSP claims investigation that involves the collection of data on other health insurance.
For more information about Medicare Secondary Payer and the providers’ role in collecting data to ensure they are billing the correct primary payer, please see the Medicare Secondary Payer Fact Sheet (PDF). MACs, intermediaries, and carriers will continue to process claims submitted for primary or secondary payment. Claims processing is not a function of the BCRC.
Questions regarding Medicare claim or service denials and adjustments should continue to be directed to your local Medicare claims office. If a provider submits a claim on behalf of a beneficiary and there is an indication of MSP, but not sufficient information to disprove the existence of MSP, the claim will be investigated by the BCRC. This investigation will be performed with the provider or supplier that submitted the claim. The goal of MSP information gathering and investigation is to identify MSP situations quickly and accurat.
Information received because of MSP data gathering and investigation is stored on the CWF. MSP data may be update as necessary, based on additional information received from external parties (e.g., beneficiaries, providers, attorneys, third party payers). CMS also relies on providers and suppliers to ask their Medicare patients about the presence of other primary health care coverage, and to report this information when filing claims with the Medicare program. Termination requests should be directed to your Medicare claims payment office. MSP records that you have identified as invalid are reported to the BCRC for investigation and deletion.
Medicare claims paying offices can terminate records on the CWF when the provider has received information that MSP no longer applies (e.g., cessation of employment, exhaustion of benefits). The BCRC’s trained staff will help you with your COB questions. Whether you need a question answered or assistance completing a questionnaire, the Customer Service Representatives are available to provide you with quality service. Click the Contactslink for BCRC contact information.
In order to better serve you, please have the following information available when you call: 1. If you cannot furnish a provider number that matches the BCRC’s database, you will be asked to submit your request in writing. If you are unable to provide the correct information, the BCRC cannot release any beneficiary specific information. Contact your local Medicare Claims Office to: 1. Answer your questions regarding Medicare claim or service denials and adjustments. Process claims for primary or secondary payment. Accept the return of inappropriate Medicare payment.
The Coordination of Benefits Agreement (COBA) Program establishes a nationally standard contract between CMS and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data. CMS has provided a COBA Trading Partners customer service contact list as an avenue for providers to contact the trading partners. The COBA Trading Partners document in the Download section below provides a list of automatic crossover trading partners in production, their identification number, and customer contact name and number. For additional information, click the COBA Trading Partnerslink.
The Medicare Learning Network (MLN) is a CMS initiative to ensure Medicare physicians, providers and supplies have immediate access to Medicare coverage and reimbursement rules in a brief, accurate, and easy to understand format. To access MLN Matters articles, click on the MLN Matterslink. Note: The information obtained from this website application, Noridian Medicare Portal, is as current as possible. There are times in which the various content contributor primary resources are not synchronized or updated on the same time interval.
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