Intermediaries/Carriers
Contents
1.2. COBC will not perform development 9 Lead Contractor Assignment Change Improved Feature Change of venue is normally referenced when speaking of workers compensation cases However for purposes of ECRS you will request a change in venue in any case where the appointment of lead hae changed from one lead contractor to another Remember lead is assigned by the COBC based on beneficiary state of residence however if another state has jurisdiction over a WC case the Medicare contractor will more than likely find out through case management and subsequently notify the COBC The expectation is that these types of requests will be few and mainly limited to WC cases It is necessary for the COBC to send the change of venue letter so that all parties are adequately notified of the new lead contractor therefore suppression of this notification should be ae used A RO or the original lead contractor will have the authority to request a change of venue Suppression of the change of venue letter should never occur when an entity e g attorney beneficiary has previously received notification and Medicare s Right of Recovery notice from the COBC Only one change in venue may be requested for a beneficiary Ifa subsequent request is made the user will receive an error In this situation the user should contact their COB consortia representative To request a change in venue the user enters a new action code of CV Change of Venue on the E
3. CRS CWF Assistance Request Detail Screen Because this is an automated process no other action code can be used in addition to CV Additionally the user must enter the new lead contractor number in the CHANGE LEAD TO FIELD 10 ECRS MSP Lead Contractor Assignment Screen Improved Feature The Workers Compensation Indicator WC Y or Space on the Lead Contractor Assignment Screen is being changed to a two position indicator field A different indicator will display for certain types of Lead assignments The values are WC Workers Compensation Set Aside Cases CV A change of venue was requested from the original lead contractor or RO and NA No action is required for this record The case has been investigated and resolved COBC s only action is to post the record to the CWF This will only be set when the CL or SL Action code is used on an MSP Inquiry If none of the above indicators apply to the MSP record the indicator field will display spaces 11 ECRS MSP Changed Record Notification Screen New Feature Approved RO MSP Coordinators will have the ability to view changed records for their RO site 12 CWF Assistance Requests New Feature In association with the new I record rules to be systematically implemented in January 2003 Medicare contractors should submit a CWF assistance request with the DR action code when there is a deleted MSP record at CWF and you receive information that indicate
4. Department of Health amp Program Memorandum Human services onns Intermediaries Carriers Madinuid Sacvives CMS Transmittal AB 03 050 Date APRIL 25 2003 This Program Memorandum re issues Program Memorandum AB 02 140 Change Request 2441 dated October 11 2002 The only change is the discard date all other material remains the same CHANGE REQUEST 2441 This Program Memorandum PM supersedes the ECRS manual reference in AB 02 116 dated August 7 2002 Please disregard the ECRS manual reference in AB 02 116 immediately SUBJECT Data Center Testing and Production Electronic Correspondence Referral System ECRS User Manual 5 1 and Quick Reference Guide Replacement On August 8 2002 the Coordination of Benefits Contractor COBC will transmit ECRS Version 5 0 to all data centers for testing through established AT amp T Global Network and Advantis telecommunication lines Data centers should complete testing within the standard testing timeframes A replacement version of ECRS as a result of testing was transmitted to all data centers on September 7 2002 This PM version replaces the current ECRS 5 0 User Manual and Quick Reference Guide In addition it highlights additional changes as a result of ECRS 5 0 testing SNECRS 1 3 is compatible with ECRS 5 1 Attachment 1 highlights new and improved features within the Program Memorandum PM and specific processing requirements to be followed The ECRS Version 5 1 draft manual at Att
5. Notice No action will be required by the submitter SL Submission of a MSP inquiry with the SL action code will alert the COBC to suppress the assignment of lead This should only be used by the lead contractor in cases where the case is already being worked or is in an open status and has not yet settled or closed The only action that is necessary by the COBC is to accrete the MSP record to the CWF SR Submission of MSP inquiry with the SR action code will alert the COBC to assign lead but suppress Medicare s Right of Recovery Notice This action should be used in cases where the notice is not necessary e g Sulzer Inter Op Class Action In addition this action may also be used in cases where you have already begun working a case and the lead assignment is necessary for notification of action by other interested contractors 7 Class Actions New Feature Designated lead contractors are assigned to be the lead for certain class action suits When a contractor or RO wants to add a record for a class action suit they will use the CA action code and enter class action suit type in the CA field The designated lead for the type entered will be assigned You will be prompted to suppress Medicare s Right of Recovery Notice The identified Class Action suits are 01 Gel Implants TrailBlazers and Alabama refer to the lead contractor listing for State by State responsibilities 02 Bone Screw Recoveries United Government Serv
6. achment 2 is being supplied for Medicare contractor and CMS RO use for maneuvering through the systems application test processes Attachment 3 is the ECRS Quick Reference Guide Instructions for Printing and Folding Quick Reference Card To print the ECRS Quick Reference Card 1 When printing the ECRS Quick Reference Card print only the first page then manually feed the paper back into your printer to print the second page To fold the ECRS Quick Reference in a Z fold 2 With the title page side up bring the right edge of the sheet up to meet the dotted line on the left and fold it 3 Turn the page over clockwise Bring the right side of the sheet up to meet the crease you just made and fold it Problems encountered by data centers should be reported to the Group Health Incorporated GHI help desk technical support staff at 212 615 4647 or 212 615 4677 Medicare contractors and RO MSP Coordinators may contact Alberta Smythe at 646 458 6694 In addition you may e mail questions concerns to the COBC via Internet address at COB ghimedicare com If Medicare contractors are unable to receive technical assistance after contacting Alberta and their RO MSP representative contact Danielle Barbour at 410 786 6468 or email her at DBarbour cms hhs gov RO MSP Coordinators should contact Danielle Barbour if they are unable to receive technical assistance CMS Pub 60AB The effective date for this PM is October 7 2002 The implement
7. ation date for this PM is October 7 2002 These instructions should be implemented within your current operating budget This PM may be discarded after April 15 2004 3 Attachments Attachment 1 Highlighted New and Improved Features in ECRS 5 1 I RO Access and Capabilities New Features This version of ECRS allows approved RO MSP Coordinators to submit Common Working File CWF Assistance Requests and MSP Inquiries Records posted to the CWF as a result of a RO submission will post with contractor number 11109 II Workers Compensation WC Set Aside Trust Screens Improved Feature The system shall allow the effective date on the Workers Compensation Set Aside Detail screen to be future dated NOTE A future CWF release will allow future effective dates for WC set aside cases to be sent directly to the CWF This is a necessary function for WC set aside cases Future dated records will be recycled through the Coordination of Benefits COB system until this change is made in the CWF Compromise WC records should be sent through the MSP Inquiry screen 3 ECRS Developing Contractor Notification Screen Improved Features The ECRS MSP Developing Contractor Notification Screen will display the attorney name and number and or insurer name and number when the submitting Medicare contractor or RO enters this information on the original MSP Inquiry This screen has also been changed to allow approved RO MSP Coordinators to view sub
8. exception for ORIG CNTR field when ACTION S CV p 2 7 2 13 3 Added 07 and 85 values for REASON fields p 2 11 2 12 2 27 2 28 Codes were added to ECRS Quick Reference Card New Features The COBC will use the 07 reason code to indicate that your request is receiving additional review research by a COBC auditor In addition the COBC will use the 85 reason code to indicate that as a result of development research the MSP situation will handled by another contractor based on change of venue 4 Removed INS REL field on Page 2 of 2 of the CWF Assistance Request Detail Screen p 2 16 2 17 and the ECRS MSP Inquiry Detail Screen p 2 32 2 33 5 Added DE and WU values for IN field on ECRS MSP Lead Contractor Assignment Screen New Features The DE value was added as a tracking tool for intermediaries when a lead assignment is subsequently deleted by the COBC The WU value was added to denote a lead assigned as a result of a particular WC agreement i e California WC agreement As the COBC secures voluntary agreements with non EGHP entities additional value codes will be added 6 Added 86 reason code for CWF Assistance Request p 2 12 Code was added to ECRS Quick Reference Card Improved Feature The 86 reason code will be used when the COBC s development research efforts are unable to verify a Medicare s contractor request related to validating changing updating address fields on the CWF
9. ices 03 Diet Drug Recoveries Cahaba BCBS Shield Alabama 04 Sulzer Inter Op Acetabular Shells for Hip Implant Recoveries Chisolm Administrative Services and 05 ae Orthopedic amp defective knee replacement recoveries Chisolm Administrative ervices 8 Voluntary Refund and Check Development Change in Process When an ECRS user enters CHEK in the source field they will be required to enter the check amount date and number in the CHECK AMOUNT CHECK DATE and CHECK NO fields The CHECK DATE field will not accept a future date This information will be displayed on the development letter to the provider insurer or employer Medicare contractors should no longer submit I records when a voluntary refund or check is received An MSP inquiry or CWF assistance request should be submitted Follow the examples below to determine which ECRS transaction to submit e An MSP inquiry should be submitted when there is no existing or related MSP record on the CWF e CWE assistance request should be submitted when the information on the CWF is incorrect or the MSP record has been deleted Submission of an MSP inquiry or CWF assistance request allows the COBC to develop to other entities other than the beneficiary e Ifthe check voluntary refund will open and close the case MSP issue you should submit an MSP inquiry with a termination date and with the case closed i e CL action code An MSP record will be added to the CWF however the
10. mitted cases which were subsequently assigned to a lead contractor for the coordination of Medicare recovery activities 4 Improved Reason Codes for MSP Inquiries Improved Feature The MSP Inquiry screen will display additional reason codes to provide ECRS users with more detail about why a record did not post to the CWF The following reason codes will be used with a completed status 69 Developed to GHP no response 70 Developed to non EGHP no response 71 Developed to the beneficiary no response 72 Developed to the informant no response 73 Medicare Beneficiary Retired 74 Spouse Retired 75 GHP lifetime of yearly benefits maxed 76 No coverage with insurance company 77 Medicare Supplemental Plan 78 Employer has less than 20 employees 80 Employer has less than 100 employees 81 Medicare is primary due to ESRD coordination period and 82 Per Insurance seasonal employee and not eligible for the month The following reason code will be used with an on hold status 13 Duplicate Request development already in process 5 Improved Reason Codes for CWF Assistance Requests Improved Feature The CWF Assistance Request screen will display additional reason codes to provide ECRS users with more detail about why a record did not post to CWF 73 Medicare Beneficiary Retired 74 Spouse Retired 75 GHP lifetime of yearly benefits maxed 76 No coverage with ins
11. s MSP and additional development must be initiated by the COBC This action code should only be used when there is a deleted record at CWF You should not submit a MSP inquiry in these cases CR 2240 AB 02 107 dated July 31 2002 indicates that where you cannot submit an T record submit an MSP Inquiry in all cases This statement is incorrect and CR 2240 will be reissued with appropriate corrections The source code DVLP was removed from the list of CWF assistance request Updated Changes to 5 0 as a Result of Testing and Comments The ECRS 5 0 software Reference Manual and Quick Reference Card have been replaced with ECRS 5 1 The following denote changes that affect Medicare contractor ECRS submissions 1 Deleted action code EA from ECRS CWF Assistance Request Detail Screen Page 1 of 2 Te oein and screen description p 2 6 2 10 This was deleted from the ECRS Quick Reference Card Change in Process The EA action code was used with the source code DVLP in previous versions of ECRS This action code was mistakenly deleted in ECRS 5 0 and will be added in a subsequent release In the interim when submitting a CWF assistance request for employer development use action code EI In comments indicate develop for employer SNECRS 1 3 included DVLP as a valid option to use with ECRS 5 1 This option is not compatible with ECRS 5 1 and will be removed in a subsequent version of SNECRS 2 Added
12. t the COBC to develop with the employer only DI Submission of a MSP inquiry with the DI action code will alert the COBC to develop with the insurer only SC Submission of a MSP inquiry with the SC action code will alert the COBC to suppress sending a confirmation to the beneficiary Normally when the COBC sends a MSP record to the CWF the beneficiary automatically receives a letter identifying what information is contained on the MSP record on the CWF We have found that in some instances this is confusing to the beneficiary in particular when Medicare s Right of Recovery Notice is also being sent 1 SC and EGHP Suppression of the confirmation letter will be allowed with EGHP MSP inquiries when the informant is the beneficiary If information received by the beneficiary indicates that they would like to receive a copy of Medicare s file pertinent to their MSP status do not suppress the confirmation letter If the beneficiary is satisfied that you have submitted the information on their behalf to the COBC and does not require confirmation of the submitted transaction you may suppress the confirmation letter Suppression of the confirmation letter will not be permitted in ECRS where the informant is not the beneficiary 2 SC and Non EGHP Suppression of the confirmation letter will automatically occur in non EGHP MSP inquiries where the process will result in a cc to the beneficiary of Medicare s Right of Recovery
13. urance company 77 Medicare Supplemental Plan 78 Employer has less than 20 employees 79 Per employer Medicare Beneficiary is not covered under spouse s GHP 80 Employer has less than 100 employees 81 Medicare is primary due to ESRD coordination period 82 Per Insurance seasonal employee and not eligible for the month 83 Incoming request conflicts with information on file and 84 Insufficient information to update CWF 6 Additional Action Codes New Features ECRS will allow a user to enter an action code to request a special process for an MSP inquiry entry The following seven action codes will be implemented with the October release CA Class Action Suit CL Closed or Settled Case DE Develop to the Employer DI Develop to the Insurer SC Suppress Confirmation Letter SL Suppress Lead Contractor Assignment and SR Suppress Right of Recovery Letters CA Submission of a MSP inquiry with the CA action code will alert the COBC that the beneficiary is party to a class action suit When this action code is used you must also identify the corresponding class action type code see 6 below CL Submission of a MSP inquiry with the CL action code with alert the COBC that the beneficiary s case has settled and you are requesting no formal action other than the MSP record to be added to the Common Working File CWF DE Submission of a MSP inquiry with the DE action code will aler
Download Pdf Manuals
Related Search
Intermediaries/Carriers