Claims Processing Instructions for the Designated A/B MAC (B)

100.4 - Claims Processing Instructions for the Designated A/B MAC (B) (Rev. 866, Issued: 02-17-06, Effective: 07-01-06, Implementation: 07-03-06) The designated A/B MAC (B) shall follow normal procedures to enroll the Drug Vendors as provider specialty type, 95, Competitive Acquisition Program (CAP) for Part B Drug Vendors. A separate 4 position, alpha-numeric vendor identification number (VIN) shall be assigned to be used in the prescription number and a master list of which numbers are assigned to which vendors shall be kept. The designated A/B MACs (B) shall forward the VIN to the A/B MACs (B) and to CMS 14 days after new CAP vendor contractors have been announced by CMS. CMS will post the VIN on the CMS Web site. A/B MACs (B) shall download these identification codes from the CMS Web site and added them to the A/B MAC (B)’s table. For subsequent CAP years, this date will be the first Monday in November. These codes shall be added to the A/B MACs (B)’s table by 14 days after receipt. The designated A/B MAC (B) shall track the name, the address, zip code, and phone number of each practice location/shipping address (location where the drugs will be administered), PIN, UPIN, (or NPI when effective), and e-mail (if available) of the physicians and physician groups and which vendors and which drugs they have chosen. In addition, the mailing/correspondence address (where the participating CAP physician can be contacted directly) for each physician shall also be tracked. This information shall be made available to CMS upon request. On a quarterly basis, the designated A/B MAC (B) shall manually add additional HCPCS codes to the information above when received from the A/B MACs (B). They shall add this information by 14 days after its receipt from the A/B MACs (B). The designated A/B MAC (B) shall only process CAP claims from approved drug vendors submitted in the ASC X12 837 professional claim format. All vendor claims shall be processed by the designated A/B MAC (B). These will not include claims for United Mine Worker, Railroad or Medicare Advantage beneficiaries.