CMS has learned that Part A providers (such as hospitals, skilled nursing facilities, home health agencies and hospices) may be receiving paper notices (114 Reports) from their Medicare Administrative Contractor (MAC) that contain error code “000000,” with no further information as to why their patients’ claims cannot be crossed over to supplemental insurers. This sometimes happens when the CMS Benefits Coordination & Recovery Center (BCRC) makes an exception to its H25407 compliance edit (“Admitting diagnosis must be used because this claim is for inpatient services.”) for HIPAA 837 version 5010A2 claims. This exception is made for 21x type of bills, for example, in accordance with current CMS claims processing policy.
Providers that bill 11x and 18x type of bills to Medicare should include an admitting diagnosis code on their incoming claims. Providers that receive letters from MACs that contain error code “000000” will need to balance bill their patients’ supplemental insurers.