PDE Guidance for Post Point-of-Sale Claim Adjustments
Guidance for sponsors to help determine the appropriate course of action for post POS adjustments. This guidance will explain the four types of coverage errors and the expected course of action for addressing the errors. Based upon the guidance, sponsors are expected to use their judgment to determine which error a specific scenario falls within and take the appropriate course of action.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 03, 2013
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.