CMS To Terminate Common Working File for Eligibility

The Common Working File (CWF) is a single data source for Fiscal Intermediaries and Carriers to verify beneficiary eligibility and conduct prepayment review and approval of claims from a national perspective. It is the only place in the fee for service (FFS) claims processing system where full individual beneficiary information is housed. CWF has four quarterly releases that control, implement, and update software changes due to legislative mandates. Software changes for the claims processing operations are managed in quarterly releases developed through a change control process that begins with the Medicare Change Control Board (MCCB) review and prioritization of pending requests. The FFS Operations Board approves the quarterly releases with oversight by the FFS Governance Council and manages/integrates day-to-day operations of the FFS program across CMS. The FFS claims processing environment is distributed across four (4) claims processing modules and one (1) integrated testing module. This investment directly supports the PMA Improve Financial Performance, as it is an essential component ensuring that accurate payments are made for medically necessary services and are provided to eligible beneficiaries by qualified providers of care. The impact of not funding CWF would be detrimental to Medicare, introducing system errors, causing harmful delays in claims processing and payment, and reducing the access, availability, and provision of health care services to Medicare beneficiaries. Error-free releases that implement legislative mandates with minimal interruption to processing ensure that beneficiaries receive the correct service and providers receive the correct payment. Current Common Working File submitters must seek alternative solution Effective April 1, 2013, the Centers for Medicare and Medicaid Services (CMS) is required to eliminate the Common Working File provider query for eligibility.  What does this mean for you? If you currently use Common Working File queries to verify Medicare eligibility, you must implement an alternative solution by April 1, 2013.