Preventing Claim Rejections with Reason Code 39001 There has been an increase in the number of claims rejected with reason code 39001. Claims are rejected when Common Working File (CWF) records indicate that the beneficiary is a member of a Medicare Advantage Organization (MAO). Once a beneficiary becomes a member of an MAO, one of the plans that they can choose to join is a Medicare Health Maintenance Organization (HMO). When a beneficiary is a member of a Medicare HMO, the Medicare HMO is responsible for paying their health care claims. The Medicare HMO replaces traditional Medicare, and traditional Medicare cannot be billed until the beneficiary terminates with that HMO. To prevent this billing error, providers should check CWF prior to submitting the claim to determine if a beneficiary has selected a Medicare HMO. If the CWF records show that a beneficiary has selected an HMO, the provider should bill the HMO instead of billing Empire Medicare Services (EMS). Medicare HMOs are identified on CWF with a “C” in the option code field of the HMO record. If there is a “1” in that field, that claim can be submitted to EMS. A problem has been identified where the disenrollment information for the HMO has not been updated on CWF. EMS is working with the Centers for Medicare & Medicaid Services (CMS) on this issue. Providers can find additional information on this problem and its resolution by going to the EMS Web site www.empiremedicare.com, and selecting View Part A Production Issues under the “What Do You Want to Do?” heading. Listed below is the input needed once you log into OMNIPRO to check CWF for the HMO information and a sample of an HMO record.
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