Tracking Overpayments and Appeals

9.5.1 - Tracking Overpayments and Appeals (Rev. 921, Issued: 11-06-19 Effective: 11-04- 19, Implementation: 11-04-19) The RAC shall enter the required information into the RACDW and provide updates throughout the claims review process. The MAC shall upload all applicable adjustment outcome files into the RACDW on a daily (business day) basis. The MAC shall forward Health Integrated General Ledger Accounting System (HIGLAS) outcome/transaction files, if files are not sent in an automated fashion and shall ensure that the VDC return the appropriate Fiscal Intermediary Shared System/ Mandatory Claim Submission System/Viable Information Processing Systems Medicare System (FISS/MCS/VMS) files directly. Any MAC unable to meet such requirements in the required timeframe shall communicate with the CMS COR regarding the surrounding circumstance and the potential for alternate instruction. The RAC shall notify the MAC of any files that the RAC did not receive from the VDC so the MAC can try to assist with the transfer of these files. The MAC shall not make adjustments on RAC-initiated zero dollar claims unless the MACs are contacting the provider to notify them of a new denial reason.