US · guidance
CMS Pub. 100-08, ch. 9, § 9.5.1
Tracking Overpayments and Appeals
The RAC shall enter the required information into the RACDW and provide updates
throughout the claims review process. The MAC shall upload all applicable adjustment
outcome files into the RACDW on a daily (business day) basis. The MAC shall forward
Health Integrated General Ledger Accounting System (HIGLAS) outcome/transaction
files, if files are not sent in an automated fashion and shall ensure that the VDC return the
appropriate Fiscal Intermediary Shared System/ Mandatory Claim Submission
System/Viable Information Processing Systems Medicare System (FISS/MCS/VMS)
files directly. Any MAC unable to meet such requirements in the required timeframe
shall communicate with the CMS COR regarding the surrounding circumstance and the
potential for alternate instruction.
The RAC shall notify the MAC of any files that the RAC did not receive from the VDC
so the MAC can try to assist with the transfer of these files.
The MAC shall not make adjustments on RAC-initiated zero dollar claims unless the
MACs are contacting the provider to notify them of a new denial reason.
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
4b98d711fe52c6387ce84981ca7c857175c26aeac98ce8524b0feff27ff460fa
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