Further Development Is Required

30.2 - Further Development Is Required (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) The A/B MAC (Part A) submits an ECRS request to the MSP Contractor when the following billing situation occurs: • Claim with primary insurer identification, no primary payer amounts, and nothing indicated in remarks field; • Beneficiary has a black lung CWF record, bill is submitted with a black lung CWF record, and bill is submitted with a black lung diagnosis, but without the primary amount shown or without an Medicare Summary Notice (MSN), or without remarks, which denies the black lung claim; • MSP claim filed with very low primary payment (investigate for possible keying error with provider to ensure accurate payment amount) (Note: A/B MACs and DME MACs A/B MACs and DME MACs must set the threshold that constitutes a very low primary payment amount. A/B MACs and DME MACs must evaluate this threshold amount on an annual basis); • Diagnosis code, no MSP record, and claim does not show occurrence code 05 and date nor remarks; • Retirement dates same as dates of service (i.e., improper use of occurrence codes 18 and 19); • Occurrence codes 01-04 used, but not MSP claim. No occurrence code 24 or remarks; and • No value code and zero dollars showing request for conditional payment.