Program_Memos / 2002 / AB-02-155

Why This Topic Matters

It affects how Medicare denial messages are communicated to beneficiaries and how contractor staff respond to questions about the policies involved. Organizations responsible for claims review and beneficiary communications need to understand the timing and operational expectations described in the memorandum.

Article Sections

1. Beneficiary Notification of Denials Based on Local Medical Review Policy

   Introduces the memorandum’s purpose and the updated notice requirements tied to denial decisions involving local medical review policies. Summarizes the general timeframe for rollout across Medicare contractors.

2. New MSN Message

   Describes the new Medicare Summary Notice language to be added when the policy-based denial notice applies. Also notes that Spanish-language versions should be made available where appropriate.

3. MR Activities

   Covers operational steps for configuring edits, handling denials, and supporting postpayment communications. Addresses how medical review and related staff should coordinate on these activities.

4. Customer Service Activities

   Outlines expectations for customer service representatives responding to beneficiary questions, including how to help obtain copies of the referenced policy. Also discusses escalation and response timing for requests.

5. Effective Date / Implementation / Budget / Discard Date

   Summarizes the memorandum’s effective date, implementation schedule, budget guidance, contractor exception, and retirement date for the instruction set. Includes contact information references at a high level.