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What types of reviews does a RAC perform?

April 26, 2017perform RAC Reviews types

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What types of reviews does a RAC perform?

1 Answer

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A. The RACs review claims on a post-payment basis and are authorized to conduct 2 types of reviews. In an automated review, the RAC will make a determination without evaluating medical records. In complex reviews, the RAC makes determinations based on its review of medical records. In a complex review, a provider has 45 days plus 10 calendar days mail time to submit requested medical records to the RAC.