Track and consider the results of appeals in your medical review activities. It is not an efficient use of medical review resources to deny claims that are routinely appealed and reversed. At a minimum, publish an article about PCA in your next regularly scheduled provider bulletin. Include PCA as a regular part of your ongoing medical review training and new provider orientation training. In addition, request assistance from state medical societies to help with provider education.
Provider includes physicians, suppliers, etc.
A definition of provider can be found in the PIM Exhibit 1. To the extent possible, implement sections of this program memorandum that do not require systems changes by October 1, 2000. These instructions should be implemented within your current operating budget. This PM may be discarded after January 1, 2002.