Medicare_Carriers_Manual / 12100 / 12100.9_Definitions.--

Why This Topic Matters

Understanding these definitions helps readers recognize when a Medicare determination may be revisited and how certain types of record errors are categorized within carrier procedures.

Article Sections

1. A. New and Material Evidence

   Defines the type of evidence considered relevant for reopening a prior determination and discusses the role of additional development.

2. B. Clerical Error

   Describes the types of human and mechanical mistakes treated as clerical errors for reopening purposes.

3. C. Error on Face of the Evidence

   Explains when a determination is considered incorrect based on the record available at the time of the decision.

4. D. Illustrations

   Provides broad examples of situations treated as errors on the face of the evidence, including separate timing contexts for reopening.

5. E. Unfavorable Determination

   Defines what makes a determination unfavorable in terms of the amount paid versus the amount claimed.