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  • Handling Claims With Certain Code Identifiers
  • Post author
    Lacy Gaskins

Handling Claims With Certain Code Identifiers

The Centers for Medicare & Medicaid Services (CMS) requests that Medicare Administrative Contractors (MACs) work with the Common Working File (CWF) and other elements to handle claims with certain ‘26’ and ‘42’ code identifiers as set forth in the Social Security Act.

Full Transmittal:

Subject: Instructions to Process Services Not Authorized by the Veterans Administration (VA) in a Non-VA Facility Reported With Value Code (VC) 42

Number: 3718

Title: 9818

Release Date: Feb. 14, 2017

Effective Date: Oct. 1, 2013

Implementation Date: April 3, 2017

Special Notes: Transmittal 3635, dated October 28, 2016, is being rescinded and replaced by Transmittal 3718, dated, February 14, 2017 to add a business requirement for CWF to allow inpatient claims with value code ‘42’ and condition code ‘26’. All other information remains the same.


  • Post author
    Lacy Gaskins

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