CMS Pub. 100-06, ch. 6, § 210.1

B3-13312.1

Heading - The carrier enters its assigned carrier number in the indicated space. In the space

labeled, "Reporting Period", it enters the numerical month and year for which the report is

prepared, e.g., it shows 1001 for the month October 2001. For each of the 8 pages of the report,

the "Type" of claim is pre-entered by the CROWD system. Page 1 will be labeled "PEN" and be

used to report PEN claims (HCPCS codes B0000-B9999; J0000-J9999). The remaining pages (2

thru 8) will be labeled and defined as follows:

PAGE TYPE HCPCS Codes

2 OXY (oxygen) E0400-E0499; E1351-E1499

3 NOE (non-oxygen equipment) E0000-E0399; E0500-E1350

4 DIA (dialysis supplies) A4650-A4927; E1500-E1649

5 NDS (non-dialysis supplies) A4200-A4640; A5051-A9999

6 PRO (prosthetics and orthotics) L0000-L9999; V0000-V9999

7 OTH (other than the previous types

above) An example would be regional-wide code

8 TOT (total DMEPOS claims)

If a claim contains more than one category type, the carrier reports the claim under each type

identified. For example, it reports a claim including services for oxygen (OXY), non-oxygen

equipment (NOE), and dialysis supplies (DIA) under page 2 (OXY), under page 3 (NOE), and

under page 4 (DIA). As a result, this claim will end up being counted as 3 claims under page 8

(TOT).

For each of these types (pages 1 through 8), it enters data for lines and columns as follows:

Lines - data reflecting the total of all States and territories in its jurisdiction (region). On

subsequent lines (2 and greater), enter data for each State and territory in its region.

Columns

Column 1, State Code - A code for the total of all States and an alpha code for each State and

territory is pre-entered by the CROWD system.

Total Claims Processed for Type Indicated

Column 2, Number - total number of DMEPOS claims processed for type indicated during the

month for all States and territories in its region.

The carrier reports claims in the month the payment date or other final adjudication occurs. See

MCM-2, §5240, functional standard 11, for definition of payment date for all claims, including

those fully denied or having charges applied completely towards the deductible. The total number

of claims for all States (line 1) must be equal to or greater than the number reported on page 9, line

38, column 1 of the CMS-1565 that the carrier submits for the same month.

Column 3, In 1-60 Days - total number of DMEPOS claims in type indicated processed within 60

days during the month for all States and territories in its region. To calculate the processing time

for a claim, the carrier subtracts the Julian receipt date from the processed to completion Julian

date. The total number of claims processed for all States must be equal to or greater than the

number reported on page 9, lines 1-35, of column 1 of the CMS-1565 submitted by the carrier for

the same month.

Column 4, In 61-90 Days - total number of DMEPOS claims in type indicated processed in 61-90

days during the month for all States and territories in its region. The total number of claims

processed for all States (line 1) must be equal to or greater than the number reported on page 9,

line 36, column 1 of the CMS-1565 submitted by the carrier for the same month.

Column 5, Mean Processing Time - mean processing time for number of DMEPOS claims for

type indicated processed during the month for all States and territories in its region. See §140.2

for an explanation on calculating the mean processing time. The carrier enters data to one decimal

place.

Column 6, EMC - number of DMEPOS claims for type indicated processed to completion that

were received via electronic media for all States and territories in its region. It does not include

claims that the carrier receives in hardcopy and transfers to electronic media via character

recognition devices. The total number of claims processed for all States (line 1) must be equal to

or greater than the number reported on page 9, line 38, column 6 of the CMS-1565 that the carrier

submits for the same month.

Clean Claims Processed for Type Indicated

Column 7, Number - total number of clean DMEPOS claims for type indicated processed during

the month for all States and territories in its region. "Clean" claims are those that do not require an

investigation or development external to the carrier operation on a prepayment basis. See MCM-

2, §5240, functional standard 11, for definition of clean claims. The total number of "clean"

claims processed for all States (line 1) must be equal to or greater than the number reported on

page 9, line 38, column 2 + 4 of the CMS-1565, the carrier submits for the same month.

Column 8, In 1-30 Days - number of clean DMEPOS claims for type indicated processed 1-30

days for all States and territories in its region.