Medicare Claims Processing Manual (Pub. 100-04), Ch. 3 § 20.2.1.1

Paying Claims Outside of the MCE

Last amended: 2008Year: 2008Length: 94 wordsOfficial source
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.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 3 § 20.2.1.1: Paying Claims Outside of the MCE | Justis AI