Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1356 Date: March 6, 2014

Transcription

1 anual ystem Pub One-Time Notification epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 1356 ate: arch 6, 2014 hange Request 8456 Transmittal 1336, dated ebruary 5, 2014, is being rescinded and replaced by Transmittal 1356, dated arch 6, 2014 to hange the ffective and mplementation ates of this hange Request to October 1, 2014 and October 6, ll other information remains the same. UBJT: odifying the aily ommon orking ile () to edicare Beneficiary atabase (B) ile to nclude iagnosis odes on the ealth nsurance Portability and ccountability ct ligibility Transaction ystem (T) 270/271 Transactions. URY O NG: This R instructs the to send up to 25 iterations of diagnosis codes associated with P no-fault, liability, and workers compensation records (hereafter referred to as nongroup health plans (NGPs)) for inclusion on the T 271 response transaction. T T: October 1, 2014 PLNTTON T: October 6, 2014 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTRUTON: (N/ if manual is not updated) R=R, N=N, =LT-Only One Per Row. R/N/ N/ PTR / TON / UBTON / TTL. UNNG: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the statement of ork. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.. TTNT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

2 ttachment - One-Time Notification Pub Transmittal: 1356 ate: arch 6, 2014 hange Request: 8456 Transmittal 1336, dated ebruary 5, 2014, is being rescinded and replaced by Transmittal 1356, dated arch 6, 2014 to hange the ffective and mplementation ates of this hange Request to October 1, 2014 and October 6, ll other information remains the same. UBJT: odifying the aily ommon orking ile () to edicare Beneficiary atabase (B) ile to nclude iagnosis odes on the ealth nsurance Portability and ccountability ct ligibility Transaction ystem (T) 270/271 Transactions T T: October 1, 2014 PLNTTON T: October 6, GNRL NORTON. Background: The T 270/271 process is used by providers, physicians, and other suppliers to reply to queries received concerning individual beneficiary eligibility information under the edicare program. This includes information found on the edicare econdary Payer (P) auxiliary file. lthough most P information from the P record is currently included on the T 271 response transaction, nternational lassification of iseases () linical odification () diagnosis codes are not included. The enters for edicare and edicaid ervices () believes it would be beneficial for to include - diagnosis codes, as derived from P no-fault, liability, and workers compensation P auxiliary records, on the interface file that it sends to B. Through a separate edicare dvantage Prescription rug change request, will ensure that the B table information that is exchanged with T will be modified to include diagnosis codes. iagnosis codes will be included in the T 271 response transaction that makes available to providers, physicians, and other suppliers. This R instructs to send up to 25 iterations of diagnosis codes associated with P no-fault, liability, and workers compensation records (hereafter referred to as non-group health plans (NGPs)) for inclusion on the T 271 response transaction. B. Policy: The T 271 response transaction should include as much information as possible to assist providers, physicians, and suppliers in identifying which diagnosis codes are relevant to given NGP cases. The diagnosis codes that the provider community will access via the T 270/271 process will assist providers, physicians, and other suppliers in better determining when edicare is the secondary payer.. BUN RQURNT TBL "hall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number Requirement Responsibility /B hared- ystem aintainers Beginning October 1, 2014, shall include the 10 diagnosis codes in the daily to B file transmission, if they are present within active P B

3 Number Requirement Responsibility /B hared- ystem aintainers NGP auxiliary records. B shall modify the daily file that it exchanges with the B to include up to 25 - diagnosis codes derived from the P NGP occurrences available within the P auxiliary file shall include a 1-byte lead diagnosis indicator to be associated with each - diagnosis code included on its daily file sent to the B. (NOT: alid 1-byte indicator values include 0 for -10; 9 for -9). f there is no diagnosis code, the indicator value shall be a space The B and U databases shall be modified to accept up to 25 iterations of the 1-byte lead diagnosis indicator, as well as up to 25 iterations of the - diagnosis code per P NGP record This information shall be included as part of the T 271 response transaction to providers, physicians, and other suppliers. ll application s and business owners listed in the backgroun d section of this R. T shall work with the B to coordinate a refresh of all past P NGP records within the B table that would not have included diagnosis codes. NOT: This refresh shall also be coordinated with the QRP (B to OB replication tool) team and the OB (Oracle B arehouse) to U T database TL (xtract, Translate, and Load Process) team shall include the ource ode received from OB in its daily to B file n accordance with the 12 standard, the T application shall not include -9 diagnosis code(s) for an P start date on or after 10/1/ n accordance with the 12 standard, the T application shall not include -9 diagnosis code(s) for an P start date prior to 10/1/2014, if the T T

4 Number Requirement Responsibility /B hared- ystem aintainers requested date or date range on the 270 begins on or after 10/1/ n accordance with the 12 standard, the T application shall include -10 diagnosis code(s) for an P start date prior to 10/1/2014 and an P end date on or after 10/1/2014 if the requested date or date range on the 270 has an end date on or after 10/1/ T shall continue to return an 42 error when an invalid diagnosis code is obtained from the data base and such invalid codes shall not be returned to providers, physicians, and other suppliers. B T T. PROR UTON TBL Number Requirement Responsibility LN rticle : provider education article related to this instruction will be available at ducation/edicare-learning-network-ln/lnattersrticles/ shortly after the R is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their eb sites and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in the contractor s next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. /B B. UPPORTNG NORTON ection : Recommendations and supporting information associated with listed requirements: N/ "hould" denotes a recommendation.

5 -Ref Requirement Number Recommendations or other supporting information: ection B: ll other recommendations and supporting information: N/. ONTT Pre-mplementation ontact(s): Richard azur, or Brian Pabst, or Post-mplementation ontact(s): ontact your ontracting Officer's Representative (OR) or ontractor anager, as applicable.. UNNG ection : or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of ork. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.