Modification of the Common Working File (CWF) Copybook to Transmit WC Qualifier Alpha Codes to Various System
MLN Matters® Number: MM6438
Related Change Request (CR) #: 6438
Related CR Release Date: May 1, 2009
Effective Date: October 1, 2009
Related CR Transmittal #: R487OTN
Implementation Date: October 5, 2009
Provider Types Affected
Physician, providers and suppliers who bill Palmetto GBA for services related to workers’ compensation liability claims.
Provider Action Needed
This article is based on Change Request (CR) 6438 and is informational only for providers. In order to prevent Medicare’s paying primarily for future medical expenses that should be covered by workers’ compensation Medicare set-aside arrangements (WCMSA), a prior instruction from Medicare, CR 5371, provided your Medicare contractors with instructions on the creation of a new Medicare Secondary Payer (MSP) code in Medicare’s claims processing systems. With the creation of the new MSP code, the Centers for Medicare & Medicaid Services (CMS) has the capability to discontinue conditional payments for diagnosis codes related to WCMSA settlements.
Background
A WCMSA is an allocation of funds from a workers’ compensation (WC) related settlement, judgment or award that is used to pay for an individual’s future medical and/or future prescription drug treatment expenses related to a workers’ compensation injury, illness or disease that would otherwise be reimbursable by Medicare. (The WC qualifier denotes a Workers’ Compensation Medicare Set-aside Arrangement.) CMS has a review process for proposed WCMSA amounts and updates its systems in connection with its determination regarding the proposed WCMSA amount. For additional information regarding WCMSAs, visit http://www.cms.hhs.gov/WorkersCompAgencyServices.
Even though the WC qualifier was added by CR 5371, no adjustment was made to allow for the transfer of the WC modifier’s alpha codes from the CWF system to other important Medicare systems and CR 6438 will implement that transfer.
Additional Information
If you have any questions, please contact our Provider Contact Center at our toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.