decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 3319 / 3319
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Article Overview
This policy guidance explains Medicare carrier handling of claims that require additional supporting evidence. It covers request timing, written follow-up, beneficiary assistance considerations, involvement of medical staff or local medical society when information is unavailable, and the timing of claim adjudication when evidence is not received. The article is relevant to claims processing staff, billing personnel, and others responsible for Medicare claim development and resolution.
Why This Topic Matters
Understanding this guidance helps claims teams process incomplete claims consistently, communicate required follow-up appropriately, and avoid premature claim disposition when additional evidence or outside assistance may still be needed.
Article Sections
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Ed. Note: For further information see
A brief editorial note directing readers to related guidance in another claims filing reference.
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3319. Disposition of Claims Where Supporting Evidence Is Needed
Procedural guidance on requesting additional information for claims, following up on unresolved evidence requests, and handling cases when supporting information is delayed or unavailable.
What You Will Learn
- How Medicare carrier claims are handled when supporting evidence is missing
- When and how follow-up requests for additional information are made
- What factors affect claim adjudication when requested evidence is not received
- When beneficiary assistance or outside intervention may be considered
- How unresolved claims are moved toward appropriate resolution
Who Should Read This
- Medicare claims processors
- Billing and reimbursement staff
- Provider office staff
- Medical office administrators
- Claims compliance personnel
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