CMS

Change To Scheduled Claims Crossover Process

The new Medicare claims crossover process previously scheduled to go live on July 1, 2004 will not be implemented as anticipated, and instead, a pilot test will be conducted on July 1, 2004 through Oct 1, 2004, when approximately 8 Coordination of Benefits Agreement (COBA) trading partners will participate as beta-testers in a parallel production crossover environment. Implementation for the full eligibility based crossover process is now scheduled for October 4, 2004.

Medicare Claims Processing

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2004

Publication Date: April 16, 2004
Effective Date: July 1, 2004

CMS has released Transmittal 141 announcing that there will be no update to the NCD laboratory edit module for July 2004. Contractors should continue to use the version that was included in the April 2004 release.

Reference:  Pub. 100, Transmittal 141, Change Request 3210.

Payment of Referral Services

Publication Date: February 6, 2004
Effective Date: July 1, 2004

CMS has released Transmittal 85 stating carrier standard systems will price the payment of referred services based upon the zip code of where the service was performed versus the current use of a reference use only PIN.

Reference:  Pub. 100-04, Transmittal 85, Change Request 3090.

Medicaid Illinois

IDPA HIPAA Implementation Status Update and Contingency Plan Information

Medicaid Illinois has released the latest update for the 835 Remit

Note 1 - IDPA exchanges remittance advice information only with the designated Payee. Please check directly with your designated Payee for information related to the 835 - Remittance Advice. Regardless of the 835, it should be noted that IDPA intends to continue to exchange the current paper remittance advice with the designated Payee for an indefinite amount of time.

Reference:  IDPA HIPAA Implementation Status.

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