decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2000 / AB-00-93
Subscribe or sign in to view the full article.
Article Overview
This article explains HCFA guidance for intermediaries and carriers on coordinating with the Y2K Program Safeguard Contractor and managing review-related communications, documentation, referrals, and follow-up. It is useful for program integrity, medical review, and claims operations staff who need to understand the operational workflow, confidentiality expectations, and effective dates associated with the memorandum and its attached statement of work language.
Why This Topic Matters
The memorandum clarifies how contractor and regional office teams are expected to coordinate review activity and handle resulting referrals or administrative actions. That makes it relevant to organizations responsible for program integrity workflows, claims review support, and provider-facing follow-up processes.
Article Sections
-
Background
Introduces the purpose of the memorandum and the broader contractor coordination context. Summarizes the types of review outcomes that may result from data analysis.
-
CCPR Coordination
Outlines the coordination workflow for coordinated comprehensive provider review activity. Describes the roles of regional office staff, contractor contacts, and documentation exchange.
-
CCPR Referrals from the PSC
Summarizes how findings from review activity may be referred onward for additional action. Covers follow-up responsibilities, communication support, and related administrative handling.
-
Non-CCPR Referrals
Describes preliminary referral handling outside the coordinated review process. Addresses tracking, status reporting, prioritization, and confidentiality expectations.
-
Attachment
Contains the attached statement of work excerpt governing review activity and coordination details. Provides the broader procedural context referenced by the memorandum.
-
Program Safeguard Contractor (PSC) Umbrella Statement of Work
Introduces the attached statement of work section referenced by the memorandum. Serves as the policy framework for the review process described in the attachment.
-
Postpayment Claim Review
Presents the statement of work language describing postpayment review and coordinated provider review activity. Includes general discussion of review scope, timing, participation, and site visit considerations.
What You Will Learn
- How the memorandum frames contractor coordination for program integrity activity.
- What types of review-related outcomes may follow contractor data analysis.
- Which organizational roles are involved in the review workflow.
- What kinds of documentation and communication are associated with review support.
- How referral handling, tracking, and confidentiality are addressed in the guidance.
- How the attached statement of work situates the review process in a broader policy context.
Who Should Read This
- Medicare intermediaries
- Medicare carriers
- Program integrity staff
- Medical review staff
- Benefit integrity staff
- Regional office staff
- Contract managers
- Claims operations personnel
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com