Furnishing Title XVIII Claims Information

460.1 - Furnishing Title XVIII Claims Information (Rev. 33, 2-6-04) A1-1602.1, B1-4602.1 The contractor shall furnish Medicare billing information to Medicaid upon request of the State agency or its fiscal agents. It shall provide it at no charge to Medicaid as long as the information can be used in the format given by Medicare: • A copy of the billing/claims form; • A copy of the Medicare Summary Notice; • A copy of the billing form and any attachments thereto; or • Electronic transfer containing the information described in Medicare Claims Processing Manual, chapter 28. Where the State has the systems capacity to process data generated in electronic media, the contractor shall provide the information at no charge. Where the State does not have the capacity to process electronic data but must use hardcopy, there is no charge for the information. If, however, the State or its fiscal agent has the capacity to process electronic data, but requests the information on hardcopy, the contractor shall charge the State $.30 per claim for the information furnished. The RO has the responsibility of determining whether the States have the systems capacity. Some State agencies may want the contractor to furnish the information in a format other than the standard format described in Medicare Claims Processing Manual, chapter 28. If the contractor is willing to undertake such additional services for the State, it shall develop an agreement with the State. It shall include terms by which the State will reimburse it on a reasonable cost basis for the additional service provided. The cost includes both direct and indirect costs. For more details regarding how the crossing over of claims to State Medicaid agencies will be handled under the COBA process, refer to Pub.100-04, Chapter 28, §70.6