Creation of a Weekly Report for Claims That Have Pended

100.5.6 - Creation of a Weekly Report for Claims That Have Pended More Than 90 Days and Subsequent Action (Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17) The shared system shall create a weekly report for the designated A/B MAC (B) providing information on claims that have pended for more than 90 days. The designated A/B MAC (B) shall review the weekly report to identify and deny claim lines for which the 90 day time period has expired. Before denying the claim lines, the designated A/B MAC (B) shall determine if the physician claim had been submitted as a paper claim. If there is an approved physician paper claim for the beneficiary with the same HCPCS code and a date of service within 7 days of the date of service of the vendor drug claim posted at CWF and the details are not denied, the designated A/B MAC (B) shall pay the claim lines. If there is no claim on file that matches these criteria, or some details are denied, the designated A/B MAC (B) shall deny the corresponding claim lines. The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two. Group Code: CO CARC: 107 RARC: N/A MSN: 21.21