100-06 Medicare Financial Management Manual: Chapter 10 - Fee for Service Claims Administration Contractor and Workload Identification
us-cms-medicare-manuals-pub-100-06-fin106c10100-06 Medicare Financial Management Manual: Chapter 10 - Fee for Service Claims Administration Contractor and Workload IdentificationGuidance
Medicare Financial Management Manual Chapter 10 - Fee-for-Service Claims Administration Contractor and Workload Identification Table of Contents (Rev. 47, 06-25-04) Transmittals for Chapter 10 10- General Information 20- Structure of the Workload Identifier 30- Initial Implementation 40- Basic Requirements and Uses of the Identifier 50- Maintenance of Contractor Workload Identifiers Exhibit 1- Contractor Workload Identifiers
10 - General Information (Rev. 47, 06-25-04) The CMS will assign to every claims administration contractor a contractor workload identifier for each geographic workload area that is included in the contractor’s jurisdiction. These contractor workload identifiers shall be the officially recognized identifier for the contractor. The contractor workload identifier will provide a unique identifier for each type of claim processed (Intermediary, Regional Home Health Intermediary, Carrier, and Durable Medical Equipment Carrier), the geographic jurisdiction associated with that claim, and the contractor that processed the claim or other transaction. The contractor workload identifier will be used by contractors in claims processing operations and to track the flow of transactions among the contractor and CMS claims administration systems. The identifier will also be used for general management and workload reporting. CMS will assign a single contractor number that contractors will use for financial management and reporting of administrative costs and program benefits. The Center for Medicare Management in CMS will have the authority and responsibility for assigning all contractor workload identifiers and for maintenance of the identifiers as contractor or workload configurations change. Exhibit 1 shows the master list of all officially recognized identifiers. 20 - Structure of the Workload Identifier (Rev. 47, 06-25-04) The CMS will assign the contractor workload identifier. It will consist of a combination of data to comprise a nine-digit alpha-numeric contractor workload identifier: • The first five characters will be a five-digit contractor number. • The next four characters represent the Business Segment Identifier (BSI) and consist of the following: o A two character contract jurisdiction code: For fiscal intermediary, carrier and regional home health intermediary workloads, the code will be the official United States Postal Service (USPS) state abbreviation for the state jurisdiction.
For durable medical equipment regional carriers, these two positions will identify the DME region, for example Region A will be RA. o A one-character modifier to identify the type of Medicare FFS contract: Fiscal intermediary = A Carrier = B Regional home health intermediary = R Durable medical equipment regional carrier = D. o The final digit will be filled with a space. This structure recognizes that CMS considers there to be four different “types” of contractors, based on the types of claims they process for beneficiaries and providers in every state. The BSI distinguishes the customers in the geographic areas served and the type of claims administered: • For fiscal intermediaries – Providers in the state served plus any providers in other locations that nominated the FI to process its claims, and any chains (of providers) assigned to the FI. • For carriers and regional home health intermediaries – Providers in the state served. • For DMERCS – Suppliers serving beneficiaries that reside in the DMERC’s jurisdiction. 30 - Initial Implementation (Rev. 47, 06-25-04) While CMS will assign the contractor number, the initial implementation of the BSI will require the claims administration contractors to assign the state codes (positions 6 and 7 of the contractor workload identifier) to their providers according to the master list on exhibit 1. Contractors shall assign the BSI as follows: • Fiscal intermediaries shall assign each provider they service to a specific state associated workload based on the state in which the provider is located. Intermediaries shall assign providers not located in the contracted state jurisdiction (i.e. providers that are “out of area” through nominations and/or chains of providers that elect the FI) according to the following rules:
o If the “out of area” provider or chain of providers is serviced through a nomination of selected contractor or a chain relationship, assign the provider to the state-associated workload to which the nomination relates. o If the “state” of the nomination cannot be determined, assign the provider to the state represented by the contractor’s home office for administrative budget and cost reporting purposes. EXAMPLE: A fiscal intermediary services Part A providers in States XX, YY and ZZ, as well as providers in several other states that nominated the FI or previous intermediaries, the workloads of which are now awarded to the current FI. Providers serviced by this FI should be assigned to either XX, YY or ZZ and would be coded XXA_, YYA_, or ZZA_ respectively. • Carriers shall assign the state code based on where the physician or supplier is located. EXAMPLE: A carrier services Part B providers in States XX and YY and will utilize XXB_ and YYB_ respectively. • RHHIs shall assign a state code based on where the home health agency or hospice is located or, if a chain of providers, where the home office is located. • DMERCs shall assign codes as follows: DMERC Region A = RAD_ DMERC Region B = RBD_ DMERC Region C = RCD_ DMERC Region D = RDD_. 40 - Basic Requirements and Uses of the Identifier (Rev. 47, 06-25-04) The contractor workload identifier will be required for interface among the basic claims processing systems including FISS, MCS, CWF, HIGLAS, REMAS, and PECOS. All claims administration systems shall be capable of tracking claims activity and identifying claims administration databases by the new BSI. Claims administration contractors shall produce management and workload reports by the unique contractor workload identifier. Claims administration contractors shall track financial management activities and produce financial reports for both administrative costs and program benefits by the corporate contractor number assigned by CMS.
50 - Maintenance of Contractor Workload Identifiers (Rev. 47, 06-25-04) There are several major circumstances that may require changes or updates to the contractor workload identifiers. Maintenance of the identifiers, including the contractor number and the BSI, will be the responsibility of the Center for Medicare Management, which will notify the affected claims processing contractor of any changes. • Contractor Transitions - The new or incoming contractor will be instructed by the CMS transition manager about any changes in the contractor workload identifier, both the contractor number and the BSI. • Provider Change of Intermediary - The BSI of a Part A provider (e.g., hospital, skilled nursing facility, home health agency, etc) may change when CMS approves a provider’s request for change of intermediary or the provider’s request to submit all bills to a single intermediary because of a chain relationship. CMS will advise the new intermediary, as well as the former intermediary, of the required change in the BSI through the tie-in notices which are necessary to coordinate the change of intermediary process. • Generally, the BSI of carriers and DMERCs will not change, but CMS will advise of any changes during any contractor transition. New Systems Implementations - As contractors are implemented on HIGLAS and REMAS, transactions that are converted into the HIGLAS and REMAS databases shall be converted with their appropriate BSI(s) to distinguish different workloads. CMS will advise for any HIGLAS implementation. Exhibit 1 (Rev. 47, 06-25-04) Contractor Workload Identifiers __________________________________________________________________ State Contract Contractor Workload Identifier Type CROWD Business Identifier Segment Multiple FI Mutual of Omaha 52280 NTA_ Multiple Carrier Railroad Retirement Board 00882 RRB_ (Palmetto) Alabama FI Cahaba 00010 ALA_ Carrier Cahaba 00510 ALB_ RHHI Palmetto 00380 ALR_
DMERC Palmetto 00885 RCD_ Alaska FI Noridian 00322 AKA_ Carrier Noridian 00831 AKB_ RHHI UGS 00454 AKR_ DMERC CIGNA 05655 RDD_ Arizona FI BCBS Arizona 00030 AZA_ Carrier Noridian 00832 AZB_ RHHI UGS 00454 AZR_ DMERC CIGNA 05655 RDD_ Arkansas FI BCBS Arkansas 00020 ARA_ Carrier BCBS Arkansas 00520 ARB_ RHHI Palmetto 00380 ARR_ DMERC Palmetto 00885 RCD_ California FI UGS 00454 CAA_ Carrier NHIC- Northern CA 31140 CAB_ Carrier NHIC- Southern CA 31146 CAB_ RHHI UGS 00454 CAR_ DMERC CIGNA 05655 RDD_ Colorado FI TrailBlazer 00400 COA_ Carrier Noridian 00824 COB_ RHHI Cahaba 00011 COR_ DMERC Palmetto 00885 RCD_ Connecticut FI Empire 00308 CTA_ Carrier First Coast 00591 CTB_ RHHI AHS Maine 00180 CTR_ DMERC HealthNow 00811 RAD_ Delaware FI Empire 00308 DEA_ Carrier TrailBlazer 00902 DEB_ RHHI Cahaba 00011 DER_ DMERC HealthNow 00811 RAD_ District of FI Carefirst of MD 00190 DCA_ Columbia Carrier* TrailBlazer 00903 DCB_ *Includes parts of MD and VA RHHI Cahaba 00011 DCR_ DMERC AdminaStar 00635 RBD_ Florida FI First Coast 00090 FLA_
Carrier First Coast 00590 FLB_ RHHI Palmetto 00380 FLR_ DMERC Palmetto 00885 RCD_ Georgia FI BCBS Georgia 00101 GAA_ Carrier Cahaba 00511 GAB_ RHHI Palmetto 00380 GAR_ DMERC Palmetto 00885 RCD_ Hawaii * FI UGS 00454 HIA_ Carrier Noridian 00833 HIB_ RHHI UGS 00454 HIR_ DMERC CIGNA 05655 RDD_ * Includes Guam and American Samoa Idaho FI Regence 00350 IDA_ Carrier CIGNA 05130 IDB_ RHHI UGS 00454 IDR_ DMERC CIGNA` 05655 RDD_ Illinois FI AdminaStar 00131 ILA_ Carrier Wisconsin Physicians Svc 00952 ILB_ RHHI Palmetto 00380 ILR_ DMERC AdminaStar 00635 RBD_ Indiana FI AdminaStar 00130 INA_ Carrier AdminaStar 00630 INB_ RHHI Palmetto 00380 INR_ DMERC AdminaStar 00635 RBD_ Iowa FI Cahaba 00011 IAA_ Carrier Noridian 00826 IAB_ RHHI Cahaba 00011 IAR_ DMERC CIGNA 05655 RDD_ Kansas FI BCBS Kansas 00150 KSA_ Carrier BCBS Kansas 00650 KSB_ RHHI Cahaba 00011 KSR_ DMERC CIGNA 05655 RDD_ Kentucky FI AdminaStar 00160 KYA_ Carrier AdminaStar 00660 KYB_ RHHI Palmetto 00380 KYR_ DMERC Palmetto 00885 RCD_ Louisiana FI Trispan 00230 LAA_
Carrier BCBS Arkansas 00528 LAB_ RHHI Palmetto 00380 LAR_ DMERC Palmetto 00885 RCD_ Maine FI Associated Hospital of ME 00180 MEA_ Carrier NHIC 31142 MEB_ RHHI Associated Hospital of ME 00180 MER_ DMERC HealthNow 00811 RAD_ Maryland FI Carefirst of Maryland 00190 MDA_ Carrier* TrailBlazer 00901 MDB_ RHHI Cahaba 00011 MDR_ DMERC AdminaStar 00635 RBD_ * See also District of Columbia Massachusetts FI Associated Hospital of ME 00181 MAA_ Carrier NHIC 31143 MAB_ RHHI Associated Hospital of ME 00180 MAR_ DMERC HealthNow 00811 RAD_ Michigan FI UGS 00452 MIA_ Carrier Wisconsin Physicians Svc 00953 MIB_ RHHI UGS 00450 MIR_ DMERC AdminaStar 00635 RBD_ Minnesota FI Noridian 00320 MNA_ Carrier Wisconsin Physician Svc 00954 MNB_ RHHI UGS 00450 MNR_ DMERC AdminaStar 00635 RBD_ Mississippi FI Trispan 00230 MSA_ Carrier Cahaba 00512 MSB_ RHHI Palmetto 00380 MSR_ DMERC Palmetto 00885 RCD_ Missouri FI Trispan 00230 MOA_ Carrier Arkansas BCBS – East MO 00523 MOB_ Carrier BCBS Kansas - West MO 00651 MOB_ RHHI Cahaba 00011 MOR_ DMERC CIGNA 05655 RDD_ Montana FI BCBS Montana 00250 MTA_ Carrier BCBS Montana 00751 MTB_ RHHI Cahaba 00011 MTR_ DMERC CIGNA 05655 RDD_
Nebraska FI BCBS Nebraska 00260 NEA_ Carrier BCBS Kansas 00655 NEB_ RHHI Cahaba 00011 NER_ DMERC CIGNA 05655 RDD_ Nevada FI UGS 00454 NVA_ Carrier Noridian 00834 NVB_ RHHI UGS 00454 NVR_ DMERC CIGNA 05655 RDD_ New FI BCBS NH/VT 00270 NHA_ Hampshire Carrier NHIC 31144 NHB_ RHHI Associated Hospital Svc 00180 NHR_ DMERC HealthNow 00811 RAD_ New FI Riverbend 00390 NJA_ Jersey Carrier Empire 00805 NJB_ RHHI UGS 00450 NJR_ DMERC HealthNow 00811 RAD_ New Mexico FI TrailBlazer 00400 NMA_ Carrier Arkansas BCBS 00521 NMB_ RHHI Palmetto 00380 NMR_ DMERC Palmetto 00885 RCD_ New York FI Empire 00308 NYA_ Carrier Empire 00803 NYB_ Carrier Group Health Inc. 14330 NYB_ Carrier HealthNow 00801 NYB_ RHHI UGS 00450 NYR_ DMERC HealthNow 00811 RAD_ North FI Palmetto 00382 NCA_ Carolina Carrier CIGNA 05535 NCB_ RHHI Palmetto 00380 NCR_ DMERC Palmetto 00885 RCD_ North Dakota FI Noridian 00320 NDA_ Carrier Noridian 00820 NDB_ RHHI Cahaba 00011 NDR_ DMERC CIGNA 05655 RDD_ Ohio FI AdminaStar 00332 OHA_ Carrier Palmetto 00883 OHB_ RHHI Palmetto 00380 OHR_ DMERC AdminaStar 00635 RBD_
Oklahoma FI BCBS Oklahoma 00340 OKA_ Carrier Arkansas BCBS 00522 OKB_ RHHI Palmetto 00380` OKR_ DMERC Palmetto 00885 RCD_ Oregon FI Regence 00350 ORA_ Carrier Noridian 00835 ORB_ RHHI UGS 00454 ORR_ DMERC CIGNA 05655 RDD_ Pennsyl- FI Veritus 00363 PAA_ vannia Carrier Highmark 00865 PAB_ RHHI Cahaba 00011 PAR_ DMERC HealthNow ` 00811 RAD_ Puerto FI* Cooperativa 57400 PRA_ Rico Carrier(PR) Triple-S 00973 PRB_ Carrier(VI) Triple-S 00974 VIB_ RHHI* UGS 00450 PRR_ DMERC* Palmetto 00885 RCD_ *Includes Virgin Islands Rhode FI Arkansas BCBS 00021 RIA_ Island Carrier Arkansas BCBS 00524 RIB_ RHHI Associated Hospital of ME 00180 RIR_ DMERC HealthNow 00811 RAD_ South FI Palmetto 00380 SCA_ Carolina Carrier Palmetto 00880 SCB_ RHHI Palmetto 00380 SCR_ DMERC Palmetto 00885 RCD_ South FI Cahaba 00011 SDA_ Dakota Carrier Noridian 00889 SDB_ RHHI Cahaba 00011 SDR_ DMERC CIGNA 05655 RDD_ Tennessee FI Riverbend 00390 TNA_ Carrier CIGNA 05440 TNB_ RHHI Palmetto 00380 TNR_ DMERC Palmetto 00885 RCD_ Texas FI TrailBlazer 00400 TXA_ Carrier TrailBlazer 00900 TXB_
RHHI Palmetto 00380 TXR_ DMERC Palmetto 00885 RCD_ Utah FI Regence 00350 UTA_ Carrier Regence 00910 UTB_ RHHI Cahaba 00011 UTR_ DMERC CIGNA 05655 RDD_ Vermont FI BCBS NH/VT 00270 VTA_ Carrier NHIC 31145 VTB_ RHHI Associated Hospital of ME 00180 VTR_ DMERC HealthNow 00811 RAD_ Virginia FI UGS 00453 VAA_ Carrier* TrailBlazer 00904 VAB_ RHHI Cahaba 00011 VAR_ DMERC AdminaStar 00635 RBD_ * See also District of Columbia Washington FI Noridian 00322 WAA_ Carrier Noridian 00836 WAB_ RHHI UGS 00454 WAR_ DMERC CIGNA 05655 RDD_ West FI UGS 00453 WVA_ Virginia Carrier Palmetto 00884 WVB_ RHHI Cahaba 00011 WVR_ DMERC AdminaStar 00635 RBD_ Wisconsin FI UGS 00450 WIA_ Carrier WPS 00951 WIB_ RHHI UGS 00450 WIR_ DMERC AdminaStar 00635 RBD_ Wyoming FI BCBS Wyoming 00460 WYA_ Carrier Noridian 00825 WYB_ RHHI Cahaba 00011 WYR_ DMERC CIGNA 05655 RDD_
Transmittals Issued for this Chapter Rev # Issue Date Subject Impl Date CR# R47FM 06/25/2004 Workload Identification - Replaces Transmittal. 43 10/04/2004 3256 R43FM 04/30/2004 Workload Identification - Replaced by Transmittal 47 10/04/2004 3256 R27FM 12/19/2003 Provider Statistical & Reimbursement Report 01/05/2004 2902 R10FM 08/30/2002 Initial Publication of Chapter N/A N/A Back to top of chapter
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