Medicare Claims Processing Manual (Pub. 100-04), Ch. 10 § 20.2.4

Only Notice of Admission (NOA) Received and Services Fall

Last amended: 2021Year: 2021Length: 163 wordsOfficial source
20.2.4 - Only Notice of Admission (NOA) Received and Services Fall Within Admission Period (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) If only an NOA has been received and the incoming claim with services subject to consolidated billing contains dates of service within the HH admission period, CWF returns an alert to the Medicare contractor to notify them that the claim may be subject to consolidated billing. The Medicare contractor processes the claim to payment, but passes on the alert to the provider on the remittance advice at the line level. The contractor shall use the following remittance advice messages and associated codes when making payment under this policy. The CARC below is not included in the CAQH CORE Business Scenarios. Group Code: CO CARC: N/A RARC: N88 MSN: N/A This indicates to providers that the services may be denied and claim payment may be recouped if later editing or another post-payment recovery process identifies the claim as subject to consolidated billing.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 10 § 20.2.4: Only Notice of Admission (NOA) Received and Services Fall | Justis AI