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NHIC, Corp. DME MAC Jurisdiction A currently performs the following Medical Review (MR) functions.

  • Performance of MR not for BI functions as outlined in MLN Matters article 5765 and the Medicare Program Integrity Manual (PIM), Chapter 5 - Items and Services Having Special DME Review Considerations;
  • Comprehensive Error Rate Testing (CERT);
  • Local Coverage Determinations (LCDs)
  • Advance Determination of Medicare Coverage (ADMC);
  • Healthcare Common Procedure Coding System (HCPCS);
  • Medical Review not for BI Claim Edits;
  • Probe Reviews;
  • Supplier Education and
  • Medical Review of Claims (not for BI purposes)
TriCenturion, a Program Safeguard Contractor (PSC), performs BI functions for DME MAC A.

Bulletins

Medical Policies (Local Coverage Determinations(LCD))

HCPCS Codes / Modifiers

Benefit Integrity / Fraud

 

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01/15/2010