MDS Alert
MACs/Intermediaries Won't Field ZPIC Questions
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They will take your ZPIC appeals. To get an idea of how the FIs and MACs fit in the ZPIC picture, take a look at the information below provided by Palmetto GBA. "Although Palmetto GBA adjudicates claims once the review is complete, Palmetto GBA does not conduct the medical reviews requested by the ZPIC," the intermediary explains in a Zone Program Integrity Contractor update on its website. "Since these reviews are being done by an entity other then Palmetto GBA, questions and correspondence related to the review and results of the review need to be directed to the source of the request." Palmetto does receive the appeals for ZPIC denied claims. "The process for filing a redetermination based on a ZPIC decision is unchanged," the intermediary says. "In addition to following the regular appeals process, providers are also asked to include a copy of the overpayment letter from Palmetto GBA and the spreadsheet from the ZPIC or the Program Safeguard Contractor (PSC) when requesting the redetermination," states Palmetto. So if you have questions: The "contact information may be found on the additional development request (ADR) letter or providers may call the number of the ZPIC where they sent the records," Palmetto instructs.
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