US · guidance
CMS Pub. 100-04, ch. 17, § 100.5.5
Pending and Recycling the Claim When All Lines Do Not Have
a Match
(Rev. 866, Issued: 02-17-06, Effective: 07-01-06, Implementation: 07-03-06)
If the designated A/B MAC (B) receives a claim from the vendor and CWF determines
some or all of the lines on the claim do not have a match, the designated A/B MAC (B)
shall pend the claim for 90 days. However, prior to the end of the 90 day period, if at the
vendor’s request the designated A/B MAC (B) can determine that a matching paper
physician claim is on file, the designated A/B MAC (B) shall allow payment of the
approved services on the claim.
The designated A/B MAC (B) may also recycle the claim back to CWF at their discretion
to determine if a matching electronic claim has been received prior to the end of the 90
day period. No interest shall be paid on the pending claim.
History
(Rev. 866, Issued: 02-17-06, Effective: 07-01-06, Implementation: 07-03-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
1518206f7ff070e0b6e0c0371eb8bbddbe0a8817aae856c8ac519d3ce4d15dd0
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