US · guidance
CMS Pub. 100-06, ch. 2, § 30
Contractors Performing Services for Other Medicare Contractors -
A1-1302, B3-4302
When services such as provider audit, EDP processing, bill/claims processing, and
appeals are performed by a Medicare contractor for another Medicare contractor, the
receiving contractor shall report costs as subcontract costs. It shall not include the
productive hours associated with the subcontract costs on the Activity Form. See Chapter
1, §210.
The Blue Cross and Blue Shield Association (BCBSA) performs most of the Plan PRRB
appeal activity. However, some Plans still maintain their own Provider Reimbursement
Review Board (PRRB) representation and may require BCBSA assistance periodically. If
a Blue Cross Plan requests the assistance of the BCBSA in connection with a specific
PRRB appeal, BCBSA invoices the Plan for the cost and is paid by the Plan and the
standard procedures for reporting costs are followed.
History
(Rev. 2, 08-30-02)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
95cba7bf0574cd54def502f1fe6e0714bacbd26e77c81895e6b97822d330e46e
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