Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2020 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
When the Medicare Administrative Contractor (MAC) requests documentation for prepayment or postpayment review in order to make a determination about coverage and payment under Section 1862(a) (1) (A) of the Act, the provider must submit the documentation within 45 calendar days, or the claim shall be denied.
If the MAC receives the requested information after a denial has been issued for non-receipt of requested records, the MAC has the discretion to reopen the claim. Palmetto GBA's Medical Review department will reopen claims denied for non-receipt of requested medical records and will make a medical review determination on the lines previously denied if the requested documentation is received within 120 days of the claim's Remittance Advice date of denial for non-receipt.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 03/13/2020