Issue Affecting the Crossing Over of End-Stage Renal Disease Facility Claims

CMS has notified contractors/FIs that its Coordination of Benefits Contractor (COBC) was unable to cross over several thousand End-Stage Renal Disease (ESRD) facility claims (type of bill [TOB] 72x) successfully during the period from July 5 through August 16, 2010. Unfortunately, the COBC’s translator and edit validation vendor had not made accommodations, prior to July 5, 2010, for the reporting of occurrence code 51, as prescribed by CMS change request 6782. The COBC thus rejected all 72x types of bills where occurrence code 51 qualifies the KT/V collection date with edit H51103, which means "51 is not a valid NUBC code." Consequently, your local Medicare contractor would have issued a special provider notification letter to your facility specifying that Medicare did not cross over the listed claims due to H51103"51 is not a valid NUBC code." This would be true even though your Medicare remittance advice indicated that Medicare transferred your patient’s claim to a given supplemental insurer. Due to the current configuration of the COBC translator and edit validator, the COBC is unable to re-run the affected claims through its HIPAA edit validation routine to facilitate the crossing over of the affected TOB 72x claims to your patients’ supplemental insurers. The COBC made changes on August 16, 2010, to accept the reporting of the KT/V collection date, as qualified by 51, on 837 institutional TOB 72x claims. Therefore, all claims that the Medicare contractors sent to the COBC as of August 16, 2010, will no longer be rejected with code H51103. CMS has already notified all participating supplemental insurers and benefit programs of this issue. You are within your rights to now bill these insurers for any balances remaining following Medicare’s payment determination on your TOB 72x claims.

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