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CodeMap® Compliance Briefing: 8/17/07


Editor's Welcome: 

Medicare contractors use a number of unique terms to explain how they process claims. Today, we will summarize how contractors define and process complete and correct claims, otherwise known as "clean claims," as well as claims either missing vital information, or needing further information before the contractor can make a payment determination. As always, please continue to send us your questions and comments via email and we will make every reasonable effort to respond.

Sincerely,

Gregory Root, Esq.


Medicare Claims Processing Rules

by: Charles B. Root, Ph.D.

When a provider sends a claim to a Medicare contractor (carrier, fiscal intermediary, or MAC) one of three results are possible; one, the contractor promptly pays the claim; two, the contractor returns the claim as unprocessable; or three, the contractor holds the claim pending receipt of additional information. There are numerous exceptions and variations, but in most ....

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