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Last Modified: 11/4/2011
Location: FL, PR, USVI
Business: Part A
Access to beneficiary's hospice election FAQ
Q: Will the common working file (CWF) provide information on a beneficiary's hospice election, to help providers avoid receipt of reject code C7010 on our claims?
A: Yes. There are several ways providers can verify this information:
• Direct data entry (DDE) 
users can verify patient's eligibility information by using the eligibility inquiry access (ELGA).
users can verify patient's eligibility information by using the eligibility inquiry access (ELGA). • Providers may contact the interactive voice response (IVR) system by calling 1-877-602-8816. For instructions, refer to the Part A IVR operating guide .
.If you are receiving this reject it could be due to the common working file (CWF) hasn't been updated to show the patient(s) have been discharged from hospice. The zero that is shown in the "Revocation IND (indicator)" field on the CWF indicates the hospice period is still active. In order for Medicare to cover the claims this indicator would need to be changed to a one. In order for the indicator to be changed to one, the last claim submitted by the hospice provider must have an occurrence code 42 with the date of the hospice disenrollment.
If you know the patient is in a hospice election period and you treated the patient for a non-terminal condition, add condition code 07 to the claim and resubmit.
Definitions:
Reject reason code C7010
The edited inpatient or outpatient claim has 'From/Thru' date that overlap a hospice election period and is not indicated as treatment of a non-terminal condition (condition code ‘07’).
--or--
A Medicare coordinated care demonstration (MCCD) notice of election (89a) 'From' date overlaps a hospice election period.
Source: Provider Outreach and Education department
Please use your browser's back button to return to the referring page.Source: Provider Outreach and Education department
