Medicare Program Integrity Manual (Pub. 100-08), Ch. 13 § 13.3.3

Process Requirements

Last amended: 2019Year: 2019Length: 158 wordsOfficial source
13.3.3 - Process Requirements (Rev. 863; Issued: 02-12-19; Effective: 10-03-18; Implementation: 01-08-19) The requestor shall submit a valid LCD reconsideration request to the appropriate MAC, following instructions on the MAC's Web site. Within 60 calendar days of the day the request is received, the MAC shall determine whether the request is valid or invalid. If the request is invalid, the contractor shall respond, in writing, to the requestor explaining why the request was invalid. If the request is valid, the contractor shall follow the requirements below. The MAC shall open the LCD and follow the LCD process as outlined in section 13.2 of this manual or include the LCD on the MAC’s waiting list. The MAC shall respond, in writing, to the requestor notifying the requestor of the acceptance, and if applicable, wait-listing, of the reconsideration request. Contractors shall keep an internal list of the LCD Reconsideration Requests received and the dates, subject, and disposition of each one.
Medicare Program Integrity Manual (Pub. 100-08), Ch. 13 § 13.3.3: Process Requirements | Justis AI