Beacon

Resources for the Most Common Medicare Part A Provider Questions

Listed below are the most common questions received in the Cahaba Provider Contact Center.

Please click on the links below to access a listing of resources you can use to reduce the number of phone calls to Cahaba for these reasons:


Address/Phone/Fax/Web Address

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Beneficiary Demographic Information

  • Checking Beneficiary Eligibility section of the FISS Reference Guide (see information published on ELGA page 1 and ELGH page 1).
  • The Interactive Voice Response Units (IVRs)(1-877 567-7271) can be used by providers can also be used to verify beneficiary demographic information.

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Beneficiary Part B Medicare Entitlement

  • Checking Beneficiary Eligibility section of the FISS Reference Guide (see information published on ELGA page 1 and ELGH page 1).
  • The Interactive Voice Response Units (IVRs) (1-877 567-7271) can be used to verify Part B Medicare entitlement information.

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Calculation or Explanation of Payment

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Claims in a Suspended Status/Location (S/LOC)

  • Suspended claims can be identified in the Fiscal Intermediary Standard System (FISS) by the status code ”S“ (e.g., S B0100).
  • Generally, providers do not need to take action for claims in a suspended S/LOC. All claims will temporarily suspend in different S/LOCs as they process through FISS.

Below are some common suspended S/LOC codes and what they mean:

S/LOC Definition Provider Action Needed?
S B0100 System processing No
S B6001 Claim needs additional information from provider (ADR). Yes, providers should return the medical documentation within 30 days. Claim will deny on 46th day if documentation not received.
S B90XX (XX=variety of location codes) System is comparing claim data to beneficiary eligibility information posted at the Common Working File (CWF). No
S M0XXX (XXX=variety of location codes) Suspended claims/adjustment requiring manual intervention by Cahaba staff. No, except when the claim has been in the same suspended S/LOC for more than 30 days, providers are encouraged to call the appropriate Provider Contact Center.
S MRADJ A Medicare Secondary Payer (MSP) adjustment has been received; claim suspended while awaiting completion. No
S M50MR and S M51MC(for claims billed to IA) Medical Review (moves claims to this location once medical documentation has been received.) Please note: the review process may take up to 60 days to complete. No
S M5013 (for claims billed to AL)

 

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Outpatient Therapy Caps

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Overlapping Claims

  • Checking Beneficiary Eligibility section of the FISS Reference Guide (see information published on ELGA pages 1, 2, and 4, as well as ELGH page 3 and 8).
  • Access the names, provider numbers, and addresses of hospitals, skilled nursing facility (SNFs), renal dialysis facilities, hospices, and home health agencies to assist in resolving overlapping claim issues.  This resource is available on the Cost Report page of the Centers for Medicare & Medicaid Services (CMS) Web site.
    • To access hospital information, click on “Hospital Cost Report” and scroll down to the list of downloads.  Select “Hospital Names and Addresses”
    • To access skilled nursing facility information, click on “Skilled Nursing Facility” and scroll down to the list of downloads.  Select “SNF Provider ID Information.”
    • To access renal dialysis facility information, click on “Renal Facility” and scroll down to the list of downloads.  Select “Renal Provider ID Information.”
    • To access hospice information, click on “Hospice” and scroll down to the list of downloads.  Select “Hospice Provider ID Information.”
    • To access home health information, click on “Home Health Agency” and scroll down to the list of downloads.  Select “HHA Provider ID Information.”

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