Types of Review: Medical Record Review, Non-Medical Record

3.3.1 - Types of Review: Medical Record Review, Non-Medical Record Review, and Automated Review (Rev. 13008; Issued: 12-18-24; Effective: 01-17-25; Implementation: 01-17-25) This section applies to MACs, CERT, RACs, SMRC, and UPICs, as indicated. A. General Most of the claim review activities completed for the purpose of identifying inappropriate billing and avoiding improper payments are divided into three distinct types: Medical Record Review, Non-Medical Record Review, and Automated Review. The chart below indicates which contractors are eligible to perform which types of review: Prepayment Post-payment Automated Reviews Medical Non- Medical Non- Contractor Record Medical Record Medical Type Review Record Review Record Review review MACs Yes Yes Yes Yes Yes CERT No No Yes No * No RACs No No Yes No Yes SMRC No No Yes Yes No UPIC Yes No Yes Yes No *Refer to section 3.3.1.3