Postpayment Medical Record Review of Claims

3.5 - Postpayment Medical Record Review of Claims (Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20) The MACs shall initiate targeted provider-specific or service-specific postpayment medical record review only when there is the likelihood of a sustained or high level of payment error. RACs, UPICs, and SMRC shall perform postpay review of claims as outlined in their SOW.