Additional Provider Communication Regarding Automatic Adjustments for Erroneous Medically Unlikely Denials

During 2011, Medicare incorrectly denied a group of claims as Medically Unlikely. These claims were denied with an indicator of either 51MUE or 52MUE, although most of the denials during this period of time with those indicators were properly processed. CMS has created a utility to identify the claims that were incorrectly denied and process adjustments for them. At this time, it is not necessary for you to take any action. Your A/B Medicare Administrative Contractor will advise you via their website when these adjustments have been completed.