CMS Pub. 100-08, ch. 12, § 12.6.1

All CERT appeals must be expedited, and data must be corrected and finalized to ensure

its inclusion in the final national and contractor level calculations.

• To finalize an appeal, the MAC shall enter the “Date Appeal Process Finalized”.

The MAC shall enter the date for each level of appeal.

• The “Appeal Recalculated Allowed Amount” is not the paid amount. The “Appeal

Recalculated Allowed Amount” is the amount paid to the provider (or

beneficiary) plus any deductible applied to this claim plus the co-insurance

amount.

• If co-insurance or a deductible was applied to a claim resulting in no payment to

the provider, an entry of zero in the recalculated allowed amount results in

payment error equal to the deductible or co-insurance applied.

For example, if a $1,100 deductible is applied to a claim resulting in $0 claim paid

amount, the allowed amount of $1,100 should be entered as the recalculated allowed

amount. Payment errors are calculated by subtracting the recalculated amount from the

final allowed amount. If the claim paid amount of $0 was entered as the recalculated

amount a payment error of $1,100 would be calculated.

• The contractor shall access the C3HUB and correct any incorrect entries.