Medicare Claims Processing Manual (Pub. 100-04), Ch. 3 § 20.2.1.1
Paying Claims Outside of the MCE
20.2.1.1 - Paying Claims Outside of the MCE
(Rev. 1649; Issued: 12-18-08; Effective/Implementation Date: 11-25-08)
All institutional inpatient claims are routed through the MCE before they are processed to
payment. There may be special circumstances, however, when it is necessary to pay claims
bypassing MCE edits. The CMS will notify the contractor of these instances. They include:
• New coverage policies are enacted by Congress with effective dates that preclude
making the necessary changes timely; and
• Errors are discovered that cannot be corrected timely.
A/B MACs (A) are responsible for reporting problems timely.