Implementing Validated Workarounds for Shared System Claims

40.2.1 - Implementing Validated Workarounds for Shared System Claims Processing by All Medicare DME MACs (Rev. 97, Issued: 01-15-16, Effective: 09-21-15, Implementation: 09-21-15) Medicare A/B, DME contractors shall implement workarounds within the shared systems for problems when formally defined as a Priority 3 or Priority 4 without obtaining written permission from a Project Officer or Regional Office. Shared system problems that are formally defined as a Priority 3 or a Priority 4 have acceptable workarounds which provide temporarily alternative solutions. In order for a A/B/DME MACs to implement a workaround, the shared system maintainer must first validate the problem, confirm that the workaround exists, is systematically viable and does not cause adverse effects. The implementation of such workarounds will eliminate delay in adjudication of Medicare claims and the payment to providers. Utilizing a Priority 3 or Priority 4 workaround shall not diminish the integrity of the shared systems and shall not include such actions as deactivating standard edits. The shared system’s priorities are formally defined at Section 40.2 of this chapter.