Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 310.11
Effectuation of the Redetermination Decision
310.11 - Effectuation of the Redetermination Decision
(Rev. 4380, Issued: 08-30-19, Effective: 07-08-19, Implementation: 10- 01-19)
All MACs are responsible for effectuating redetermination decisions. Effectuation means for the
MAC to adjust the claim and issue a payment or to change liability. If the redetermination decision
is fully or partially favorable to the appellant and gives a specific amount to be paid, the MAC
effectuates within 30 calendar days of the date of the redetermination decision.
If the decision is fully or partially favorable, but the payment amount must be computed or
recomputed, the MAC effectuates the decision within 30 days after the payment amount is
determined. The payment amount must be computed as soon as possible, but no later than 30
calendar days after the date of the redetermination decision.