Integrated Claims Processing Systems - (Rev. 1, 08-30-02)

460.4 - Integrated Claims Processing Systems - (Rev. 1, 08-30-02) A1-1602.4, B1-4602.4 Where a State agency selects a Medicare contractor as its fiscal agent and the contractor has an integrated claims processing system, Medicare pays the full cost of operations which are required for processing title XVIII claims even though the operations benefit both the title XVIII and State medical assistance programs. Integrated operations generally include receiving, screening, determination of amount of payment, and portions of the keypunching and data processing functions. The contractor shall analyze integrated operations carefully in order to identify any functions that are not required under title XVIII but have been superimposed on the normal title XVIII claims process. For example, special coding required by the State agency, additional key punching and data processing necessary as a result of this coding, preparation of a separate check, and other similar activities are extra, identifiable functions not required in the title XVIII claims process and are not reimbursable by Medicare. State agencies are responsible for administrative costs of all extra, identifiable functions that the contractor performs while processing combined claims. The contractor shall furnish a letter of intent to the State agency. It shall clearly indicate any extra, identifiable functions that are part of integrated operations and are performed for medical assistance program purposes. It shall indicate any operations separate and apart from the integrated claims process that are performed solely for the State agency. The contractor and the State agency are responsible for establishing the terms of the agreement and the method of reimbursement. When negotiations have been completed, the contractor shall forward two copies to the servicing RO.