Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 300.4

Medical Consultants Used

Last amended: 2007Year: 2007Length: 101 wordsOfficial source
300.4 - Medical Consultants Used (Rev. 1274, Issued: 06-29-07, Effective: 07-01-07, Implementation: 10-01-07) The parties are entitled to know the identity and qualifications of any consultant whose evidence the MAC used to support the initial claim determination or the redetermination. If the MAC uses a consultant, it shall include the identity and qualifications of the consultant in the file for possible use by the ALJ, and for the appellant’s use upon request. This applies to both external medical consultants and internal staff used to review the claim. An example of this would be the name and title of the medical consultant.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 300.4: Medical Consultants Used | Justis AI