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If a provider receives payment under a Medicare or Medicaid Managed Care plan, should the managed care claims be included in the Claims Review?

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If a provider receives payment under a Medicare or Medicaid Managed Care plan, should the managed care claims be included in the Claims Review?

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No. Because the payment methodology of managed care plans typically differs from the traditional Medicare and Medicaid payment methodologies, the reviewer should not include managed care claims in its population of claims to be reviewed in the context of a CIA Claims Review.

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