System updates associated with CMS releases

06-01-2017

When the Centers for Medicare and Medicaid Services (CMS) change or update their coverage policies or pricing, they allow health plans up to 30 days to reconfigure our systems in response. At times this will not align with the implementation of the changes for traditional Medicare or Medicaid.

New or revised National and Local Coverage Determinations (NCDs and LCDs)

We update our systems with NCD and LCD changes within 30 days of the release date from CMS or local MAC carrier.

Updates to NCDs/LCDs are not retrospectively applied to claims that have already processed in our system.

Pricing/payment updates

We implement pricing updates associated with changes to the Medicare and Medicaid payment systems within 30 days of release date from CMS.

Payment system updates are not retrospectively applied to claims that have already processed in our system.