A/B MAC, DME MACs and CEDI Audit Trails

40.2.2.2 - A/B MAC, DME MACs and CEDI Audit Trails (Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13) A/B MACs and DME MACs must maintain an automated transaction tracking and retrieval capability and retain an audit trail that notes each change made to each claim from date of receipt to date of payment or denial and any subsequent adjustments. A/B MACs, and DME MACs must be able to retrieve or recreate: • The claim as received (pre-translation) from the provider, billing service, or clearinghouse (A/B MACs only); • The claim as received (post-translation) from CEDI (DME MACs only); • The claim as paid to the provider; • All adjustments made on the claim; • The check or the electronic funds transfer (EFT) record sent to the provider; and • The remittance advice as sent to the provider (A/B MACs only); • The remittance advice as sent to CEDI (DME MACs only). A/B MACs and DME MACs must maintain the ability to cross-refer all associated transactions, e.g., EFT or check, claim adjustment, remittance advice, to each related claim being processed. The records may be kept on electronic, computer-output- microfilm, optical disk media, or other reliable and industry accepted types of storage and retrieval media. They may never allow anyone to overlay or erase a record. Each record must be kept intact. All records must be archived in accordance with the instructions in the Medicare General Information, Eligibility, and Entitlement Manual, Pub. 100-01, Chapter 7. It is important to have a well-defined system for maintaining audit trail data so that data integrity is maintained at all times. CEDI must maintain an automated transaction tracking and retrieval capability and retain an audit trail that notes each change made to each claim from date of receipt to date of transfer to the appropriate DME MAC; and the receipt of remittance advice from the DME MAC and delivery to the provider. CEDI must be able to retrieve or recreate: • The claim as received (pre-translation) from the provider, billing service, or clearinghouse; • The remittance advice as sent to the provider. The records may be kept on electronic, computer-output-microfilm, optical disk media, or other reliable and industry accepted types of storage and retrieval media. They may never allow anyone to overlay or erase a record. Each record must be kept intact. All records must be archived in accordance with the instructions in the Medicare General Information, Eligibility, and Entitlement Manual, Pub.100-01, Chapter 7. It is important to have a well-defined system for maintaining audit trail data so that data integrity is maintained at all times.