Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 310.11

Effectuation of the Redetermination Decision

Last amended: 2019Year: 2019Length: 130 wordsOfficial source
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.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 310.11: Effectuation of the Redetermination Decision | Justis AI