tci Part B Insider - 2007 Issue 6

TRANSMITTAL ROUNDUP: The Faster You Answer Development Letters, The Sooner The 45-Day Clock Restarts

3 pump codes no longer covered in SNFsCarriers should process -other-than-clean- claims within 45 days, the Centers for Medicare & Medicaid Services (CMS) says in Transmittal 1173 (CR 5355). These claims require -investigation or development- outside of the contractor's Medicare operation on a prepayment basis. If the contractor sends the physician a request for additional information five days after receiving the claim, the contractor will only have 40 days left to finish processing the claim and notify the provider of the result, CMS adds.But the 45-day clock stops when the carrier sends the development letter and resumes when...

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