Cost of a Separate Claims Process - (Rev. 1, 08-30-02)

460.3 - Cost of a Separate Claims Process - (Rev. 1, 08-30-02) A1-1602.3, B1-4602.3 Where a State agency selects a Medicare contractor as its agent and a claims process separate from the Medicare claims process is developed, the cost of all functions performed in this separate process are a direct charge to the State agency. Arrangements for billing State agencies for the cost of this claims process are the contractor's responsibility. When Medicare billing information is transferred to the separate claims process, the provisions of §460.1 apply. It is possible that some operations for the separate title XVIII and medical assistance claims may be performed in the same department, possibly by the same clerk. For example, upon completion of the title XVIII claim and transfer of billing information, it may be necessary to return the claim to the files maintenance section to determine eligibility and status in the medical assistance program. Where common cost centers exist, it is the contractor's responsibility to identify the effort expended for each program and charge costs from these costs centers to the appropriate program. The cost includes both direct and indirect costs.