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| Crossover Claims Impacted by Common Working File (CWF) Pacific Host Site Problem Joint Signature Memorandum (JSM) 09321 The Centers for Medicare & Medicaid Services (CMS) is alerting all providers, physicians, and suppliers to a problem that occurred on May 4, 2009, and would have negatively impacted their patients crossover claims. On May 4, 2009, Medicare contractors that utilize the Common Working File (CWF) Pacific Host Site for paid claims authorization for their beneficiaries who primarily reside, or until recently resided, in Arkansas, California, Hawaii, and Nevada did not receive the customary confirmation from their host site that various claims were selected for crossover. The identified problem inhibiting the crossing over of claims was limited to the CWF Pacific Host s payment authorization process on May 4, 2009, and most likely would have impacted those claims billed to Part A and Part B Medicare Administrative Contractors (A/B MACs), carriers, fiscal intermediaries, and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) around April 30 or May 1, 2009. The CMS volume estimates in terms of impacted claims are as follows: approximately 78,700 Part B physician claims; over 10,000 institutional claims; and an undetermined number of DME MAC claims (claims for durable medical equipment, prosthetics, orthotics, and medical supplies). Providers, physicians, and suppliers should note that, as aforementioned, not all claims sent to the CWF Pacific Host Site on May 4, 2009, encountered crossover problems. Therefore, CMS recommendation to individual providers, physicians, and suppliers is as follows: Examine your electronic remittance advice or standard paper remittance advice to determine if your patients claims are identified as having been crossed over to your patients supplemental insurers. If you determine these claims were not crossed over, you are within your rights to submit claims to your patients insurers for supplemental payment using methodologies acceptable to those entities. Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message. To unsubscribe/change profile: click here. |
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