CMS requires all contractors to adhere to downloading the MQSA file on a weekly basis. It has been brought to CMS' attention that although the files are being downloaded, the change in certification data is not being uploaded timely by carriers, thus causing erroneous rejections of valid certified facilities. In addition, some facilities that receive certification from the American College of Radiology (ACR) are submitting claims for these services the following day after certification, which is before the systems are capable of being updated with new certification data. CMS is currently working on implementing an automatic upload process to allow for reduced processing time.
Until that process has been implemented, we suggest that providers hold their mammography claims for seven business days to allow for any changes in certification data to be uploaded accordingly. After the seven business day hold, providers may submit their claims for payment. Carriers must have all MQSA certification information uploaded into their system within seven days of downloading the file from CMS. Upon implementation of the automated process for certification data uploads, providers may discontinue holding these claims.
JSMTDL-08161