PCA is an operational principle upon which all medical review activity is based.  It serves as an approach to performing medical review and assists contractors in deciding how to deploy medical review resources and tools appropriately.   It involves data analysis, error detection, validation of errors, provider education, determination of review type, sampling claims and payment recovery. 

The contractor may use any information they deem necessary to make a prepayment or postpayment claim review determination.  This includes reviewing any documentation submitted with the claim as well as soliciting documentation from the provider or other entity when the contractor deems it necessary and in accordance with our manuals

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Page Last Modified: 12/14/2005 12:00:00 AM
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