Prepay Complex Review Workload and Cost (Activity Code

11.1.3.9 - Prepay Complex Review Workload and Cost (Activity Code 21221) (Rev. 171; Issued: 11-09-06; Effective: 01-01-07; Implementation: 12-09-06) Report all costs associated with prepay complex review in Activity Code 21221. In the workload section of CAFM II, Activity Code 21221, report the number of claims reviewed in Workload 1. Report the number of claims denied in whole or in part in Workload 2. Report the number of providers subject to prepay complex review in Workload 3. The DMERCs shall report the number of Advanced Determinations of Medicare Coverage accepted (CMS IOM Pub.100-8, chapter.5, section 5.7) to miscellaneous code 21221/01. The carriers and fiscal intermediaries shall report the therapy cap workload in activity code 27021.