Announcement Regarding Part B Paid Claims that Overlap Non-pay SNF Claims As was discussed at the March 28, 2007 Skilled Nursing Facility-Long Term Care Open Door Forum, Part B paid claims that overlap non-pay SNF claims are rejecting in error. On April 27, 2007, CMS released a change request that addresses the situation: Change Request Number 5587, Transmittal Number R274OTN, “Invalid Skilled Nursing Facility (SNF) Information Unsolicited Responses (IUR) from CWF.” This CR can be found at the Centers for Medicare & Medicaid Services (CMS) Web site 2007 Transmittals page: http://www.cms.hhs.gov/Transmittals/2007Trans/list.asp?sortByDID=2a&filterType=none&filterByDID=-99&sortOrder=ascending&intNumPerPage=10&submit.x=7&submit.y=14. CMS has commissioned the CWF maintainer to create a program that will automatically identify the Part B claims that were erroneously rejected for the FIs, Part A MACs, MCS carriers, and DME MACs. The FISS maintainer has created an additional utility that will automatically adjust the Part B claims and reinstate the payment that was erroneously recouped. The FIs will be utilizing this program during the weekend of May 26 and 27. The applicable providers will be able to view the corrected claims during the week of May 28 through June 1 and should expect payment shortly thereafter. Regarding the Part B MCS carriers and DME MACs, these contractors will be manually adjusting these claims now that CR 5587 has been released. The applicable providers will begin seeing these claims online and should expect to receive payment immediately thereafter. Part B providers are encouraged to allow the Medicare contractors to reprocess these claims and to not resubmit or adjust them in the meantime. If there are any questions or concerns relating to the timeframes in which these claims will be reprocessed, please contact the appropriate FI, carrier, or DME MAC. CMS Learn Resource 200705-02
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