Implementation of Medicare Administrative Contractor (MAC) Appeals Upload Process Changes for the Recovery Audit Contractor (RAC) Data Warehouse (RACDW) and Addition of Disposition Category "U" to RACDW Appeals Layout File
This Change Request (CR) is to implement the solutions discussed during analysis calls, which will require the Part A Medicare Administrative Contracotrs (MACs) to pull and upload claim appeals data for the Qualified Independent Contractor (QIC) and Office of Medicare Hearings and Appeals/Administrative Law Judge (OMHA/ALJ) decisions into the RACDW. In addition, this CR will implement an update to the disposition field in the RACDW appeals layout that will add disposition category “U” (Underpayment Favorable) in order to correct the problem of RAC-identified underpayment appeals being incorrectly identified by the MACs with the disposition code “Fully Favorable.”
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 26, 2022
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