100-04 Medicare Claims Processing Manual: Chapter 2 Crosswalk

Medicare Claims Processing Manual
Chapter 2 - Admission and Registration Requirements
Crosswalk
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Carrier
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PM 	Other 	Description
2 	01 	Purpose of Chapter
2 	05 	Definition of Provider and Supplier
2 	10 	HO-300,
HO-312
General Admission and Registration Rules
2 	10.1 	A3-3502 	B3-3200,
B3-3203
HO-304.4 	Health Insurance Claim Numbers (HICNs)
2 	10.1.1 	A3-3502 	B3-3205 	HO-304.5 	Changes to HICNs
2 	10.1.2 	B3-3208 	Contractor Procedures for Obtaining
Missing or Incorrect Claim Numbers
2 	10.1.3 	HO-304 	SNF-404 	Importance of HICNs
2 	10.2 	HO-302 	SNF-402 	Prohibition Against Waiver of Health
Insurance Benefits as a Condition of
Admission
2 	10.3 	HO-303 	SNF-317 	Requiring Prepayment as a Condition of
Admission is Prohibited
2 	10.4 	HO-303.2 	SNF-317 	When Prepayment May Be Requested

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PM 	Other 	Description
2 	10.4 	HO-303.3 	Prepayment Rules (Deductible,
Coinsurance, Noncovered Services)
2 	10.5 	HO-300 	Hospital and Skilled Nursing Facility
(SNF) Verification of Prior Hospital Stay
Information for Determining Deductible
and Benefit Period Status
2 	10.6 	HO-303.3 	SNF-317 	Hospitals May Require Prepayment for
Noncovered Services
2 	10.7 	HO-303,4 	SNF-317 	Compliance With Agreement
2 	10.8 	HO-266,
HO-307
SNF-407 	Request for Payment Should be Obtained
in All Cases as Protective Application for
Hospital Insurance Benefits
2 	10.9 	HO-308 	Intermediary Requests to Verify Patient's
HICN
2 	10.10 	HO-309 	Intermediary Learns Beneficiary is an
HMO Enrollee
2 	10.11 	HO-310 	SNF-410 	Retroactive Entitlement
2 	10.12 	SNF-414 	SNF Verification of Prior Hospital Stay
and Transfer Requirements
2 	20 	HO-300 	SNF-401 	Obtaining Information to Determine
Whether to Bill Medicare or Another
Payer

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Pub. 11
PM 	Other 	Description
2 	20.1 	HO-301 	SNF-401 	A-03-031 	Provider Development of Medicare
Secondary Payer
2 	30 	A3-3503 	HO-304,
HP-311
SNF-404 	Provider/Supplier Obtaining/Verifying the
HICN and Entitlement Status
2 	30.1 	A3-3800.2 	B3-6005.2 	Cross-Reference of HICN
2 	30.2 	A3-3501 	B3-3200 	HO-304.1 	Health Insurance (HI) Card
2 	30.3 	A3-3501 	B3-3200 	HO-304.2 	Temporary Eligibility Notice
2 	30.4 	HO-304.3 	Certificate of Social Insurance Award
2 	30.5 	HO-305 	Medicare Summary Notice (MSN)
2 	30.6 	3-3508 	B3-6100 	Provider Access to CMS and Carrier or
Intermediary Eligibility Data
2 	30.6.1 	3-3508.1 	B3-6100.1 	Rules for Accessing Eligibility Data
2 	30.6.1.1 	3-3508.3 	Part A Inquiry (HIQA) Screen Display
2 	30.6.1.2 	A3-3508.4 	Part A Inquiry Reply (HIQAR) Screen
Display-
2 	30.6.1.3 	A3-3508.5 	Part A Inquiry (HUQA)Data
2 	30.6.1.4 	A3-3508.6 	Part A Inquiry (HUQAR) Reply Data
2 	30.6.1.5 	HH-467.6 	Health Insurance Query for Home Health
Agencies HIQH)

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PM 	Other 	Description
2 	30.6.2 	B3-6100.2 	Carrier Implementation
2 	30.6.3 	B3-6100.3 	Data Format
2 	30.6.4 	B3-6100.4 	Part B Eligibility Data Security
Requirements
2 	30.6.5 	B3-6100.5 	CMS Standard Part B Eligibility Inquiry
Flat File Specifications
2 	30.6.6 	B3-6100.6 	CMS Standard Part B Eligibility Response
Flat File Specifications
2 	30.7 	Deleted
2 	30.8 	A3-3510 	Health Insurance Master Record (HIMR)
Inquiry
2 	30.9 	A3-3511 	Deleted
2 	30.10 	A3-3512 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Beneficiary Master Information
2 	30.11 	A3-3513 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Medicare Secondary Payer Information
(MSP)
2 	30.12 	A3-3514 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Group Health Organization (GHO)
2 	30.13 	A3-3515 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Hospice Enrollment
2 	30.14 	A3-3516 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Surgery Information
2 	30.15 	A3-3517 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf End Stage Renal Disease (ESRD)

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Carrier
Pub. 14
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Pub.10
SNF
Pub. 12
HH
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PM 	Other 	Description
2 	30.16 	A3-3518 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Beneficiary Cross-Reference
2 	30.17 	A3-3519 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf DMEPOS Certificate of Medical Necessity
(CMN) Display
2 	30.18 	A3-3520 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf True Not In File (TNIF) Status
2 	30.19 	A3-3521 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Claim History Information
2 	30.19.1 	A3-3521.1 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Inpatient History Overview
2 	30.19.2 	A3-3521.2 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Outpatient/HHA History Inquiries
2 	30.19.3 	A3-3521.3 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Hospice History
2 	30.19.4 	A3-3521.4 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Part B History
2 	30.20 	A3-3522 	http://cms.csc.com/cwf/downloads/docs/pdfs/overhimr.pdf Archived History Information
2 	30.21 	A3-3523 	B3-6008 	Requesting Assistance in Resolving
Problem Areas in the Inquiry/Inquiry
Response Procedures
2 	30.21.1 	A3-3523.1 	HMO-Related Master File Corrections
2 	30.22 	HO-300 	Provider Problems Obtaining Entitlement
Information
2 	50 	Critical Case Procedures - Establishing
Entitlement Under Part A and B

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PM 	Other 	Description
2 	60 	HO-306 	Provider Contacts with the SSO to Obtain
the HICN
2 	60.1 	HO-306.1 	Information Required by the Social
Security Office
2 	60.2 	HO-306.2 	The SSO Reply
2 	70 	SSO Assistance in Resolving Entitlement
Status Problems
2 	80 	HO-312 	Required Hospital Notice to Beneficiaries
2 	80.1 	HO-312A 	Notice to Beneficiaries of QIO Review of
Care
2 	80.2 	HO-312B 	Notice to Beneficiary of QIO of Need for
Continued Hospitalization
2 	80.3 	HO-312.1 	QIO Monitoring of Hospital Admission
Notice to Beneficiaries
2 	90 	HO-350 	Outpatient Hospital Registration
Procedures
2 	90.1 	HO-350A 	Patient Identification
2 	90.2 	HO-350B 	Determining Whom to Bill
2 	90.3 	HO-350C 	Source of Admission - Outpatient Hospital
2 	90.4 	HO-350D 	Type of Bill

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Int.
Pub. 13
Carrier
Pub. 14
HO
Pub.10
SNF
Pub. 12
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Pub. 11
PM 	Other 	Description
2 	90.5 	HO-350E 	Definition of Diagnostic Services
2 	90.6 	HO-350F 	Definition of Encounter
2 	100 	HSP-201 	Hospice Notice of Election
2 	100.1 	FI Reply to Notice of Election
2 	100.1.3 	HSP-302.2 	FI Reply to Notice of Election
2 	110 	ESRD Method Selection
2 	110.1 	ESRD Method of Selection Transaction to
CWF and Response
2 	120 	Religious Nonmedical Health Care
Institution (RNHCI) Admission
2 	120.1 	AB-00-30 	Election Requirements
2 	120.2 	AB-00-30 	Revocation of Election
2 	120.3 	AB-00-30 	Completion of the Uniform (Institutional
Provider) Bill (Form CMS-1450) Notice
of Election for RNHCI
2 	120.4 	AB-00-30 	Common Working File (CWF)