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Back  RFI # 793: CMS Contract ID on 271

Formal vs. Informal Help Informal Formal

Submitter

Susan Vacula

Description

Is there a specific CMS recommended location on the 271 to send a Part C Carrier's CMS Contract ID to providers? The documentation I've reviewed so far seems to indicate the 2110C Loop, REF02 segment but I want to confirm that as well as the approproate qualifier in REF01.

Response

There are several places where a Provider’s Contract Number can be returned, however the Contract Number must be the Contract Number for the entity identified in the 2100A (Information Source loop).

If the Provider’s Contract Number applies to all responses in the 271 (which would apply to all patient’s, all benefits) it may be returned in the 2100B REF02 with REF01 = CT.

If the Provider’s Contract Number applies to a specific patient and all of their associated benefits, it may be returned in the 2100C/D REF02 with REF01 = CT if the Provider is identified in the 2100C/D PRV segment.

There is no place to return a Provider’s Contract Number for a specific benefit or for another payer (2110 level).

Recommendation

In direct reference to the original questions related to the Medicare Part C Carrier:

If the Information Source identified in Loop 2100A is the Medicare Part C Carrier, the Provider’s Contract Number may be returned in either the 2100B REF or the 2100C/D REF as outlined above.

If the Information Source identified in Loop 2100A is not the Medicare Part C Carrier, it is not appropriate for an Information Source to identify the Contract Number associated with another payer. The Provider’s Contract Number must only be returned by the associated Information Source.
Submission 6/2/2009
Status Date 8/11/2009
Status F - Final
Primary References
Document 005010X279
Section2
Set ID271
Table2
Loop2110C