Application of Local Medical Review Policies

100.3 - Application of Local Medical Review Policies (Rev. 866, Issued: 02-17-06, Effective: 07-01-06, Implementation: 07-03-06) A/B MACs (B) and/or Program Safeguard Contractors shall apply all Local Coverage Determination (LCD) policies and National Coverage Determination (NCD) policies to the administration and no-pay drug code lines on the CAP claims. Should it be determined that a drug administration or drug code service line does not meet the requirements of the LCD, the A/B MAC (B) shall follow current processes to determine how to adjudicate the related services. If appropriate, the A/B MACs (B) shall include messages on the MSN and RA to indicate which LCD was applied. The A/B MACs (B) shall also apply all regular edits to the administration and no-pay drug lines and send appropriate denial messages.