Reliable Information that the Payments to Be Made May Not

8.3.1.3 – Reliable Information that the Payments to Be Made May Not Be Correct - General Suspensions (Rev.: 13762; Issued: 05-27-26; Effective: 06-29-26; Implementation: 06-29-26) A payment suspension may be implemented when the MAC or UPIC or CMS possesses reliable information that the payments to be made may not be correct. In this situation, the MAC shall refer its information to the respective UPIC for development of a potential suspension. If warranted, the UPIC shall complete the payment suspension AAR and submit the payment suspension recommendation via the UCM. The AAR shall serve as the UPIC’s documented recommendation for CMS’ consideration of a payment suspension and, when completed, include the UPIC’s findings and all pertinent provider/supplier information. The AAR, draft notice of suspension, and all other relevant documentation that supports the suspension recommendation shall be uploaded by the contractor as part of the UCM submission. For the purposes of this section, these types of payment suspensions will be called “general suspensions.” EXAMPLE (including but not limited to): Several claimed services identified from a post-payment review were determined to be non-covered or miscoded. It has been determined that the provider has not changed its billing behavior and it is suspected that there may be a continuance of non-covered or miscoded claimed services to be billed in the future.