Tracking Medicare Contractors' Prepayment and Postpayment

3.5.4 - Tracking Medicare Contractors' Prepayment and Postpayment Reviews (Rev. 11933; Issued: 03-30-23; Effective: 04-01-23; Implementation: 04-03-23) Shared System Maintainers shall create a pre-payment claim file that is automatically uploaded to the RACDW by the VDC. Medicare Administrative Contractors (MACs) shall input all postpayment complex reviews into the Recovery Audit Data Warehouse. All claims chosen for review by the MAC where an additional documentation request letter was issued to the provider before or after payment was made shall be included. MACs shall include all reviews, even those that did not result in an improper payment. Claims may be manually uploaded into the data warehouse or submitted by flat file. The Shared System Maintainers and MACs shall use the file layout provided by CMS for claims uploaded to the Recovery Audit Data Warehouse. Postpayment claims shall be submitted to the Recovery Audit Data Warehouse by the 20th day of every month for the previous month. Prepayment claims shall be submitted to the Recovery Audit Data Warehouse daily. MAC staff who need access to the Data Warehouse shall contact RAC@cms.hhs.gov.