Service Health Insurance Corporation (WPS)http://www.wpsgha.com Managed care plans use federal and state Medicaid funds to pay providers for services. Types of Reviews - View the three types of Recovery Auditor reviews and the action providers should take. 1 Cameron Hill Circle STE 0061 Estimated pay. But Medicaid hasn't studied whether including managed care payments in this program would be cost effectiveeven though managed care makes up more than half of Medicaid expenditures. Jurisdiction 14 Medical Review Spring Mill Corporate Center All rights reserved. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. Jurisdiction 14 National Heritage Insurance Company (NHIC) Direct: 972-383-0000 Service Health Insurance Corporation (WPS)http://www.wpsgha.com Noridan Healthcare Solutions, LLC This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. CPT is a trademark of the AMA. Fargo, ND 58108-6722 RAC-related news, resources and educational materials can be found on this page. Published: Jun 28, 2023. CDT is a trademark of the ADA. Accepts esMD transactions, Medical Review Jurisdiction D Note: The Noridian Provider Contact Center is only able to answer general questions about the RAC program. Wisconsin Physicians The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. Accepts esMD transactions, Part A and Part B Medicare Administrative Contractors (A/B MACS) Hospitals already face having to reduce profit margins due to low reimbursement rates and higher costs. Review Contractor Directory - Interactive Map | CMS Omaha, NE 68108-0310 The ADA is a third-party beneficiary to this Agreement. Nashville, TN 37202Ngs.cedihelpdesk@wellpoint.comhttp://cgsmedicare.com/jc/index.html Recovery Audit Contractor The Division of Medicaid has contracted with LaunchPoint Ventures dba Discovery Health Partners to administer the RAC program. means youve safely connected to the .gov website. Mechanicsburg PA 17055-1840www.novitas-solutions.com Audit Recovery - VA-FSC Internet - Veterans Affairs The scope of this license is determined by the ADA, the copyright holder. Before sharing sensitive information, make sure youre on a federal government site. California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands. Conshohocken, PA 19428 4, 4.33 "CMS Recovery Audit Program" Web page; CGS Recorded Webinar: 07.23.2020, A Discussion with Performant - Our Recovery Audit Contractor; Updated: 05.21.21 The Supplemental Medical Review Contractor is a contractor that performs Medicare medical review activities as directed by CMS. CMS Disclaimer TTY: 866-786-7155Accepts esMD transactions, Part A and Part B Medicare Administrative Contractors (A/B MACS) Jurisdiction N Columbia, SC 29202-3238http://www.palmettogba.com T: (877) 350-7992 As a result, CMS may not be determining whether states warrant full exemptions and may be missing opportunities to collect overpayments. 866-419-9458Accepts esMD transactions, Part A and Part B Medicare Administrative Contractor (A/B MAC) Chattanooga, TN 37402-0061http://cgsmedicare.com Note: The information obtained from this Noridian website application is as current as possible. You acknowledge that the AMA holds all copyright, trademark, and other rights in CPT. Generally, there are two types of Medicare RAC audits the automated audits and complex audits. To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. P.O. Fargo, ND 58108-6722 Reston, VA Office. RACs review claims on a post-payment basis. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. It goes without saying that both sides of this battle will want to apply innovative technologies in order to get the upper hand. The UPIC contracts operate in five (5) separate geographical jurisdictions in the United States and combine and integrate functions previously performed by the Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC) and Medicaid Integrity Contractor (MIC) contracts. CMS concurred with two, partially concurred with one, and disagreed with one of GAO's recommendations. Our team of audit attorneys has extensive experience in Medicare audits, including RAC, ZPIC and Safeguard (PSC) audits. If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. Its easy to see why. Fargo ND, 58108dme@noridian.comAccepts esMD transactions, Part A and Part B Medicare Administrative Contractors (A/B MAC) 1 Cameron Hill Circle STE 0061 6 Ways to Prepare for RAC Audits | Vyne Medical Recovery Audit Contractor Careers: Job Descriptions & Requirements 888-248-6950Accepts esMD transactions, SafeGuard Services LLC (SGS)http://www.safeguard-servicesllc.com/, Medical Review: Jurisdiction A DME WPS Medicare Part A 888-204-3771 (hearing impaired), Part A and Part B Medicare Administrative Contractors (A/B MAC) Suite 6125 Accepts esMD transactions, Part A and Part B Medicare Administrative Contractor (A/B MAC) Hingham, MA 02043-9146www.medicarenhic.com/dme/ PO Box 6722 Durable Medical Equipment - Medicare Administrative Contractor is a specialty MAC whose contract is awarded through competitive procedures and which provides for the processing of Medicare claims for durable medical equipment, prosthetics, orthotics, and supplies in keeping with 42 CFR 421.210. NHIC, Corp Secure .gov websites use HTTPSA More. Jurisdiction 1 Palmetto GBA: Recovery Audit Contractor Jobs, Employment | Indeed.com Nashville, TN 37202Ngs.cedihelpdesk@wellpoint.comhttp://cgsmedicare.com/jc/index.htsml Are You Prepared for a Medicare Recovery Audit Contractor (RAC) Audit Chattanooga, TN 37402-0061http://cgsmedicare.com DME- Written Inquiries Hingham, MA 02044http://www.medicarenhic.com Jurisdiction F Any questions pertaining to the license or use of the CPT must be addressed to the AMA. Jurisdiction F Hingham, MA 02043-9146http://www.medicarenhic.com/dme/ Miramar, FL 33027, (954) 988-2851 Fargo ND, 58108dme@noridian.comAccepts esMD transactions, Part A and Part B Medicare Administrative Contractors (A/B MACS) Fax: 855-420-8004, UPIC South-Western Headquarters Accepts esMD transactions, Medical Review Jurisdiction C If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. 866-238-9650 (IVR - interactive voice response) Introducing this new type of contractor has resulted in numerous questions that have yet to be answered regarding their operations and effect on practices. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Overpayments can occur when providers submit claims that do not meet CMS coding or medical necessity policies. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). Provider Contact Center: 866-931-3901Accepts esMD transactions, Part A and Part B Medicare Administrative Contractor (A/B MAC) DPDA also performs oversight of the PPI MEDIC and the Part D RAC. CMS did not consistently establish or communicate the expiration of its approvals for full exemption from the Medicaid RAC program. 3450 Lakeside Drive Nashville, TN 37202Ngs.cedihelpdesk@wellpoint.comhttp://cgsmedicare.com/jc/index.html866-270-4909 (customer service)866-238-9650 (IVR - interactive voice response)888-204-3771 (hearing impaired) 2023 Fenton Law Group, LLP.All rights reserved. Recovery Audit Contractor Determinations - Agree or Disagree - Agree or disagree with the Recovery Auditor determination? P.O. Other services use proprietary technology to examine healthcare service providers claims and determine the claims that are at risk. 866-419-9458 No fee schedules, basic unit, relative values or related listings are included in CDT. P.O. Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. Performant Recovery, Inc., is the national RAC for Home Health and Hospice providers. P.O. 888-248-6950 555 E. North Lane 866-238-9650 (IVR - interactive voice response) Accepts esMD transactions, Part A and Part B Medicare Administrative Contractor (A/B MAC) License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. GAO examined certain documents covering the Medicaid RAC program for all states and the District of Columbia, during fiscal year 2021 and interviewed CMS and state officials from a nongeneralizable sample of 11 states. Accepts esMD transactions, Part A and Part B Medicare Administrative Contractors (A/B MACS) Accepts esMD transactions, Medical Review Jurisdiction D Noridian Healthcare Solutions, LLC Jurisdiction N Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Reviews consist of Approvals (Actives) for an individual person receiving either Medicaid or the Children's Health Insurance Program (CHIP). Box 20010 P.O. 866-734-9444 MAC NGS National Government Services: Jurisdiction L Yet, providers face audits of payment claims by third-party entities, including by recovery audit contractors (RACs), that subject hospitals to administrative burden and costly payment denials after care has already been delivered.