New Timeframe for Medicare Responding
Written by Editor   
Wednesday, December 10, 2014 02:07 PM

Effective April 1, 2015, when a provider receives a pre-payment review Additional Documentation Request from a Medicare Administrative Contractor (MAC) or Zone Program Integrity Contractor (ZPIC), the provider will now have 45 calendar days to respond and supply the requested documentation. If the provider does not respond by day 46, the associated claims will be denied.

This is a positive change to the response timeframe – The current regulations (Section (A) of the Medicare Program Integrity Manual), which will remain in effect until March 31, 2015, require providers to respond within 30 calendar days.
Additional information about this revision is available in