Pub 100-08 Medicare Program Integrity: Requirement that Medicare Carrier System (MCS) Not Allow the Re-review of Previously Denied Claims
Guidance that requires the Medicare Carrier System (MCS) to stop the re-review of denials. The Medicare Program Integrity Manual (PIM) requires that the review of a line for medical review (MR) purposes be counted once, no matter how many times the same line is reviewed during claims processing. Effective July 5, 2005, the MCS system shall be revised to deny as duplicate a newly submitted claim against a claim that has been denied, medically reviewed, or where documentation was requested but not received.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 11, 2005
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