CMS Pub. 100-06, ch. 10 – Fee for Service Claims Administration Contractor and Workload Identification

Medicare Financial Management Manual

Chapter 10 - Fee-for-Service Claims Administration

Contractor and Workload Identification

Table of Contents (Rev. 47, 06-25-04)

Transmittals for Chapter 10

10- General Information

20- Structure of the Workload Identifier

30- Initial Implementation

40- Basic Requirements and Uses of the Identifier

50- Maintenance of Contractor Workload Identifiers

Exhibit 1- Contractor Workload Identifiers

10 - General Information

(Rev. 47, 06-25-04)

The CMS will assign to every claims administration contractor a contractor workload identifier for each geographic workload area that is included in the contractor's jurisdiction. These contractor workload identifiers shall be the officially recognized identifier for the contractor.

The contractor workload identifier will provide a unique identifier for each type of claim processed (Intermediary, Regional Home Health Intermediary, Carrier, and Durable Medical Equipment Carrier), the geographic jurisdiction associated with that claim, and the contractor that processed the claim or other transaction.

The contractor workload identifier will be used by contractors in claims processing operations and to track the flow of transactions among the contractor and CMS claims administration systems. The identifier will also be used for general management and workload reporting.

CMS will assign a single contractor number that contractors will use for financial management and reporting of administrative costs and program benefits.

The Center for Medicare Management in CMS will have the authority and responsibility for assigning all contractor workload identifiers and for maintenance of the identifiers as contractor or workload configurations change.

Exhibit 1 shows the master list of all officially recognized identifiers.

20 - Structure of the Workload Identifier

(Rev. 47, 06-25-04)

The CMS will assign the contractor workload identifier. It will consist of a combination of data to comprise a nine-digit alpha-numeric contractor workload identifier:

The first five characters will be a five-digit contractor number.
The next four characters represent the Business Segment Identifier (BSI) and consist of the following:
A two character contract jurisdiction code:
1. For fiscal intermediary, carrier and regional home health intermediary workloads, the code will be the official United States Postal Service (USPS) state abbreviation for the state jurisdiction.
For durable medical equipment regional carriers, these two positions will identify the DME region, for example Region A will be RA.
A one-character modifier to identify the type of Medicare FFS contract:
Fiscal intermediary = A
Carrier = B
Regional home health intermediary = R
Durable medical equipment regional carrier = D.
The final digit will be filled with a space.

This structure recognizes that CMS considers there to be four different “types” of contractors, based on the types of claims they process for beneficiaries and providers in every state. The BSI distinguishes the customers in the geographic areas served and the type of claims administered:

For fiscal intermediaries – Providers in the state served plus any providers in other locations that nominated the FI to process its claims, and any chains (of providers) assigned to the FI.
For carriers and regional home health intermediaries – Providers in the state served.
For DMERCS – Suppliers serving beneficiaries that reside in the DMERC’s jurisdiction.

30 - Initial Implementation

(Rev. 47, 06-25-04)

While CMS will assign the contractor number, the initial implementation of the BSI will require the claims administration contractors to assign the state codes (positions 6 and 7 of the contractor workload identifier) to their providers according to the master list on exhibit 1.

Contractors shall assign the BSI as follows:

Fiscal intermediaries shall assign each provider they service to a specific state associated workload based on the state in which the provider is located. Intermediaries shall assign providers not located in the contracted state jurisdiction (i.e. providers that are “out of area” through nominations and/or chains of providers that elect the FI) according to the following rules:

○ If the “out of area” provider or chain of providers is serviced through a nomination of selected contractor or a chain relationship, assign the provider to the state-associated workload to which the nomination relates.

○ If the “state” of the nomination cannot be determined, assign the provider to the state represented by the contractor’s home office for administrative budget and cost reporting purposes.

EXAMPLE: A fiscal intermediary services Part A providers in States XX, YY and ZZ, as well as providers in several other states that nominated the FI or previous intermediaries, the workloads of which are now awarded to the current FI. Providers serviced by this FI should be assigned to either XX, YY or ZZ and would be coded XXA_, YYA_, or ZZA_ respectively.

• Carriers shall assign the state code based on where the physician or supplier is located.

EXAMPLE: A carrier services Part B providers in States XX and YY and will utilize XXB_ and YYB_ respectively.

• RHHIs shall assign a state code based on where the home health agency or hospice is located or, if a chain of providers, where the home office is located.

• DMERCs shall assign codes as follows:

DMERC Region A = RAD_ DMERC Region B = RBD_ DMERC Region C = RCD_ DMERC Region D = RDD_.

40 - Basic Requirements and Uses of the Identifier

(Rev. 47, 06-25-04)

The contractor workload identifier will be required for interface among the basic claims processing systems including FISS, MCS, CWF, HIGLAS, REMAS, and PECOS.

All claims administration systems shall be capable of tracking claims activity and identifying claims administration databases by the new BSI.

Claims administration contractors shall produce management and workload reports by the unique contractor workload identifier.

Claims administration contractors shall track financial management activities and produce financial reports for both administrative costs and program benefits by the corporate contractor number assigned by CMS.

50 - Maintenance of Contractor Workload Identifiers

(Rev. 47, 06-25-04)

There are several major circumstances that may require changes or updates to the contractor workload identifiers. Maintenance of the identifiers, including the contractor number and the BSI, will be the responsibility of the Center for Medicare Management, which will notify the affected claims processing contractor of any changes.

Contractor Transitions - The new or incoming contractor will be instructed by the CMS transition manager about any changes in the contractor workload identifier, both the contractor number and the BSI.
Provider Change of Intermediary - The BSI of a Part A provider (e.g., hospital, skilled nursing facility, home health agency, etc) may change when CMS approves a provider's request for change of intermediary or the provider's request to submit all bills to a single intermediary because of a chain relationship. CMS will advise the new intermediary, as well as the former intermediary, of the required change in the BSI through the tie-in notices which are necessary to coordinate the change of intermediary process.
Generally, the BSI of carriers and DMERCs will not change, but CMS will advise of any changes during any contractor transition.

New Systems Implementations - As contractors are implemented on HIGLAS and REMAS, transactions that are converted into the HIGLAS and REMAS databases shall be converted with their appropriate BSI(s) to distinguish different workloads. CMS will advise for any HIGLAS implementation.

Exhibit 1

(Rev. 47, 06-25-04)

Contractor Workload Identifiers

State	Contract Type	Contractor	Workload Identifier
			CROWD Identifier	Business Segment
Multiple	FI	Mutual of Omaha	52280	NTA_
Multiple	Carrier	Railroad Retirement Board (Palmetto)	00882	RRB_
Alabama	FI	Cahaba	00010	ALA_
	Carrier	Cahaba	00510	ALB_
	RHHI	Palmetto	00380	ALR_

	DMERC	Palmetto	00885	RCD_
Alaska	FI	Noridian	00322	AKA_
	Carrier	Noridian	00831	AKB_
	RHHI	UGS	00454	AKR_
	DMERC	CIGNA	05655	RDD_
Arizona	FI	BCBS Arizona	00030	AZA_
	Carrier	Noridian	00832	AZB_
	RHHI	UGS	00454	AZR_
	DMERC	CIGNA	05655	RDD_
Arkansas	FI	BCBS Arkansas	00020	ARA_
	Carrier	BCBS Arkansas	00520	ARB_
	RHHI	Palmetto	00380	ARR_
	DMERC	Palmetto	00885	RCD_
California	FI	UGS	00454	CAA_
	Carrier	NHIC- Northern CA	31140	CAB_
	Carrier	NHIC- Southern CA	31146	CAB_
	RHHI	UGS	00454	CAR_
	DMERC	CIGNA	05655	RDD_
Colorado	FI	TrailBlazer	00400	COA_
	Carrier	Noridian	00824	COB_
	RHHI	Cahaba	00011	COR_
	DMERC	Palmetto	00885	RCD_
Connecticut	FI	Empire	00308	CTA_
	Carrier	First Coast	00591	CTB_
	RHHI	AHS Maine	00180	CTR_
	DMERC	HealthNow	00811	RAD_
Delaware	FI	Empire	00308	DEA_
	Carrier	TrailBlazer	00902	DEB_
	RHHI	Cahaba	00011	DER_
	DMERC	HealthNow	00811	RAD_
District of Columbia	FI	Carefirst of MD	00190	DCA_
	*Carrier	TrailBlazer	00903	DCB_

*Includes parts of MD and VA

	RHHI	Cahaba	00011	DCR_
	DMERC	AdminaStar	00635	RBD_
Florida	FI	First Coast	00090	FLA_

	Carrier	First Coast	00590	FLB_
	RHHI	Palmetto	00380	FLR_
	DMERC	Palmetto	00885	RCD_
Georgia	FI	BCBS Georgia	00101	GAA_
	Carrier	Cahaba	00511	GAB_
	RHHI	Palmetto	00380	GAR_
	DMERC	Palmetto	00885	RCD_
*Hawaii	FI	UGS	00454	HIA_
	Carrier	Noridian	00833	HIB_
	RHHI	UGS	00454	HIR_
	DMERC	CIGNA	05655	RDD_

Includes Guam and American Samoa

Idaho	FI	Regence	00350	IDA_
	Carrier	CIGNA	05130	IDB_
	RHHI	UGS	00454	IDR_
	DMERC	CIGNA`	05655	RDD_
Illinois	FI	AdminaStar	00131	ILA_
	Carrier	Wisconsin Physicians Svc	00952	ILB_
	RHHI	Palmetto	00380	ILR_
	DMERC	AdminaStar	00635	RBD_
Indiana	FI	AdminaStar	00130	INA_
	Carrier	AdminaStar	00630	INB_
	RHHI	Palmetto	00380	INR_
	DMERC	AdminaStar	00635	RBD_
Iowa	FI	Cahaba	00011	IAA_
	Carrier	Noridian	00826	IAB_
	RHHI	Cahaba	00011	IAR_
	DMERC	CIGNA	05655	RDD_
Kansas	FI	BCBS Kansas	00150	KSA_
	Carrier	BCBS Kansas	00650	KSB_
	RHHI	Cahaba	00011	KSR_
	DMERC	CIGNA	05655	RDD_
Kentucky	FI	AdminaStar	00160	KYA_
	Carrier	AdminaStar	00660	KYB_
	RHHI	Palmetto	00380	KYR_
	DMERC	Palmetto	00885	RCD_
Louisiana	FI	Trispan	00230	LAA_

	Carrier	BCBS Arkansas	00528	LAB_
	RHHI	Palmetto	00380	LAR_
	DMERC	Palmetto	00885	RCD_
Maine	FI	Associated Hospital of ME	00180	MEA_
	Carrier	NHIC	31142	MEB_
	RHHI	Associated Hospital of ME	00180	MER_
	DMERC	HealthNow	00811	RAD_
Maryland	FI	Carefirst of Maryland	00190	MDA_
	*Carrier	TrailBlazer	00901	MDB_
	RHHI	Cahaba	00011	MDR_
	DMERC	AdminaStar	00635	RBD_

See also District of Columbia

Massachusetts	FI	Associated Hospital of ME	00181	MAA_
	Carrier	NHIC	31143	MAB_
	RHHI	Associated Hospital of ME	00180	MAR_
	DMERC	HealthNow	00811	RAD_
Michigan	FI	UGS	00452	MIA_
	Carrier	Wisconsin Physicians Svc	00953	MIB_
	RHHI	UGS	00450	MIR_
	DMERC	AdminaStar	00635	RBD_
Minnesota	FI	Noridian	00320	MNA_
	Carrier	Wisconsin Physician Svc	00954	MNB_
	RHHI	UGS	00450	MNR_
	DMERC	AdminaStar	00635	RBD_
Mississippi	FI	Trispan	00230	MSA_
	Carrier	Cahaba	00512	MSB_
	RHHI	Palmetto	00380	MSR_
	DMERC	Palmetto	00885	RCD_
Missouri	FI	Trispan	00230	MOA_
	Carrier	Arkansas BCBS – East MO	00523	MOB_
	Carrier	BCBS Kansas - West MO	00651	MOB_
	RHHI	Cahaba	00011	MOR_
	DMERC	CIGNA	05655	RDD_
Montana	FI	BCBS Montana	00250	MTA_
	Carrier	BCBS Montana	00751	MTB_
	RHHI	Cahaba	00011	MTR_
	DMERC	CIGNA	05655	RDD_

Nebraska	FI	BCBS Nebraska	00260	NEA_
	Carrier	BCBS Kansas	00655	NEB_
	RHHI	Cahaba	00011	NER_
	DMERC	CIGNA	05655	RDD_
Nevada	FI	UGS	00454	NVA_
	Carrier	Noridian	00834	NVB_
	RHHI	UGS	00454	NVR_
	DMERC	CIGNA	05655	RDD_
New Hampshire	FI	BCBS NH/VT	00270	NHA_
	Carrier	NHIC	31144	NHB_
	RHHI	Associated Hospital Svc	00180	NHR_
	DMERC	HealthNow	00811	RAD_
New Jersey	FI	Riverbend	00390	NJA_
	Carrier	Empire	00805	NJB_
	RHHI	UGS	00450	NJR_
	DMERC	HealthNow	00811	RAD_
New Mexico	FI	TrailBlazer	00400	NMA_
	Carrier	Arkansas BCBS	00521	NMB_
	RHHI	Palmetto	00380	NMR_
	DMERC	Palmetto	00885	RCD_
New York	FI	Empire	00308	NYA_
	Carrier	Empire	00803	NYB_
	Carrier	Group Health Inc.	14330	NYB_
	Carrier	HealthNow	00801	NYB_
	RHHI	UGS	00450	NYR_
	DMERC	HealthNow	00811	RAD_
North Carolina	FI	Palmetto	00382	NCA_
	Carrier	CIGNA	05535	NCB_
	RHHI	Palmetto	00380	NCR_
	DMERC	Palmetto	00885	RCD_
North Dakota	FI	Noridian	00320	NDA_
	Carrier	Noridian	00820	NDB_
	RHHI	Cahaba	00011	NDR_
	DMERC	CIGNA	05655	RDD_
Ohio	FI	AdminaStar	00332	OHA_
	Carrier	Palmetto	00883	OHB_
	RHHI	Palmetto	00380	OHR_
	DMERC	AdminaStar	00635	RBD_

FI	BCBS Oklahoma	00340	OKA_
Carrier	Arkansas BCBS	00522	OKB_
RHHI	Palmetto	00380	OKR_
DMERC	Palmetto	00885	RCD_

FI	Regence	00350	ORA_
Carrier	Noridian	00835	ORB_
RHHI	UGS	00454	ORR_
DMERC	CIGNA	05655	RDD_

Pennsyl-	FI	Veritus	00363	PAA_
vannia	Carrier	Highmark	00865	PAB_
	RHHI	Cahaba	00011	PAR_
	DMERC	HealthNow	00811	RAD_

Puerto	*FI	Cooperativa	57400	PRA_
Rico	Carrier(PR)	Triple-S	00973	PRB_
	Carrier(VI)	Triple-S	00974	VIB_
	*RHHI	UGS	00450	PRR_
	*DMERC	Palmetto	00885	RCD_

*Includes Virgin Islands

Rhode	FI	Arkansas BCBS	00021	RIA_
Island	Carrier	Arkansas BCBS	00524	RIB_
	RHHI	Associated Hospital of ME	00180	RIR_
	DMERC	HealthNow	00811	RAD_

South	FI	Palmetto	00380	SCA_
Carolina	Carrier	Palmetto	00880	SCB_
	RHHI	Palmetto	00380	SCR_
	DMERC	Palmetto	00885	RCD_

South	FI	Cahaba	00011	SDA_
Dakota	Carrier	Noridian	00889	SDB_
	RHHI	Cahaba	00011	SDR_
	DMERC	CIGNA	05655	RDD_

FI	Riverbend	00390	TNA_
Carrier	CIGNA	05440	TNB_
RHHI	Palmetto	00380	TNR_
DMERC	Palmetto	00885	RCD_

Texas	FI	TrailBlazer	00400	TXA_
	Carrier	TrailBlazer	00900	TXB_

	RHHI	Palmetto	00380	TXR_
	DMERC	Palmetto	00885	RCD_
Utah	FI	Regence	00350	UTA_
	Carrier	Regence	00910	UTB_
	RHHI	Cahaba	00011	UTR_
	DMERC	CIGNA	05655	RDD_
Vermont	FI	BCBS NH/VT	00270	VTA_
	Carrier	NHIC	31145	VTB_
	RHHI	Associated Hospital of ME	00180	VTR_
	DMERC	HealthNow	00811	RAD_
Virginia	FI	UGS	00453	VAA_
	Carrier*	TrailBlazer	00904	VAB_
	RHHI	Cahaba	00011	VAR_
	DMERC	AdminaStar	00635	RBD_
** See also District of Columbia*
Washington	FI	Noridian	00322	WAA_
	Carrier	Noridian	00836	WAB_
	RHHI	UGS	00454	WAR_
	DMERC	CIGNA	05655	RDD_
West	FI	UGS	00453	WVA_
Virginia	Carrier	Palmetto	00884	WVB_
	RHHI	Cahaba	00011	WVR_
	DMERC	AdminaStar	00635	RBD_
Wisconsin	FI	UGS	00450	WIA_
	Carrier	WPS	00951	WIB_
	RHHI	UGS	00450	WIR_
	DMERC	AdminaStar	00635	RBD_
Wyoming	FI	BCBS Wyoming	00460	WYA_
	Carrier	Noridian	00825	WYB_
	RHHI	Cahaba	00011	WYR_
	DMERC	CIGNA	05655	RDD_

Transmittals Issued for this Chapter

Rev #	Issue Date	Subject	Impl Date	CR#
R47FM	06/25/2004	Workload Identification - Replaces Transmittal. 43	10/04/2004	3256
R43FM	04/30/2004	Workload Identification - Replaced by Transmittal 47	10/04/2004	3256
R27FM	12/19/2003	Provider Statistical & Reimbursement Report	01/05/2004	2902
R10FM	08/30/2002	Initial Publication of Chapter	N/A	N/A