CMS Pub. 100-04, ch. 29, § 320.9

In many cases, the QIC's decision will require an effectuation action on the MAC’s part. The

MAC does not effectuate based on correspondence from any party of the reconsideration. It

takes an effectuation action only in response to a formal decision and Reconsideration

Effectuation Notice from the QIC. "Effectuate" means for the MAC to adjust the claim and

issue a payment or to change liability. If the QIC's decision is favorable to the appellant and

gives a specific amount to be paid, the MAC effectuates within 30 calendar days of the date

of receipt of the effectuation notice from the QIC.

NOTE: CMS does not anticipate that QICs will specify an amount to be paid in

reconsideration notices.

If the decision is favorable, but the payment amount must be computed or recomputed, it

effectuates the decision within 30 days after the payment amount is determined. The amount

must be computed as soon as possible, but no later than 30 calendar days after the date of

receipt of the QIC's effectuation notice. The receipt of effectuation information shall be

reported to the appropriate QIC.

If the QIC’s decision is unfavorable, but there is a change in liability, the MAC effectuates

within 30 calendar days of receipt of the QIC’s effectuation notice.