US · guidance
CMS Pub. 100-08, ch. 9, § 9.3
Overview of the RAC Process
Upon contract award, the RACs will receive a data file from CMS containing National
Claims History (NCH) data about claims that have been processed by the MACs in the
appropriate jurisdictions based on the RAC contract. The RACs will receive monthly
updated NCH data files. RACs will enter individual claim information into the RACDW
for each claim under review. Assuming a provider or claim(s) has not been excluded or
suppressed due to a previous medical review, fraud investigation or inclusion in the
Comprehensive Error Rate Testing (CERT) sample, the RAC will continue with their
review process.
The CMS may grant the RAC “read only” access to the Common Working File (CWF)
(and any other systems at CMS’ sole discretion) to obtain additional information
pertaining to potential improper payments.
History
(Rev. 921, Issued: 11-06-19 Effective: 11-04- 19, Implementation: 11-04-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9311b7914f0bc1a7d50f33807389511a8dededd50572ccd9a784ea6f23b2d775
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