Overview of the RAC Process

9.3 – Overview of the RAC Process (Rev. 921, Issued: 11-06-19 Effective: 11-04- 19, Implementation: 11-04-19) Upon contract award, the RACs will receive a data file from CMS containing National Claims History (NCH) data about claims that have been processed by the MACs in the appropriate jurisdictions based on the RAC contract. The RACs will receive monthly updated NCH data files. RACs will enter individual claim information into the RACDW for each claim under review. Assuming a provider or claim(s) has not been excluded or suppressed due to a previous medical review, fraud investigation or inclusion in the Comprehensive Error Rate Testing (CERT) sample, the RAC will continue with their review process. The CMS may grant the RAC “read only” access to the Common Working File (CWF) (and any other systems at CMS’ sole discretion) to obtain additional information pertaining to potential improper payments.