US · guidance
CMS Pub. 100-08, ch. 7, § 7.2.2.1
Automated Medical Review
A medical review is considered automated when a payment decision is made at the
system level, using available electronic information, with no manual intervention. It
must be based on guidelines for which the contractor’s Medical Review area has
developed some or all of the logic for review of specific billing and coverage criteria
based on vulnerabilities identified by the Contractor’s Medical Review area. This
process is done completely through the Medical Review Contractors' technology
developed in response to medical review data analysis.
History
(Rev. 721; Issued: 06-09-17; Effective: 07-11-17; Implementation: 07-11-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a7f74cec6e6e2951c4cbbe322e7a9ac0025e81dcbbd903b264e5f2b2b4194a94
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