Demand Bill Claims Review

7.2.2.3 - Demand Bill Claims Review (Rev. 444, Issued: 12-14-12, Effective: 04- 01- 13 (FISS and MCS); 07-01-13 (VMS); Implementation: April 1, 2013 (Implementation of FISS and MCS); July 1, 2013 (Implementation of VMS) Demand bills are submitted at the beneficiary’s/representative’s request because the beneficiary disputes the provider’s opinion that the bill will not be paid by Medicare and requests the bill be submitted for a payment determination. The demand bill is identified by the presence of a condition code 20. There must be a written request from the beneficiary to submit the bill, unless the beneficiary is deceased or incapable of signing. In this case, the beneficiary’s guardian, relative or other authorized representative may make the request. This includes SNF and HHA demand bills as well as other demand bills (outpatient) and Third Party Liability Medical Reviews.