New Informational Unsolicited Response (IUR) Process to Identify Previously Paid Claims for Services Furnished to Medicare Beneficiaries Classified as “Unlawfully Present” in the United States

This article informs Medicare contractors about the creation of a new Informational Unsolicited Response (IUR) process to identify and perform retroactive adjustments on any previously paid claims that contain dates of service (DOS) that partially or fully overlap a period when the beneficiary was unlawfully present in the United States. The IUR process shall be initiated when there is an automatic or manual update to the beneficiary’s record in CWF which indicates a change to the beneficiary’s “unlawfully present” start date or end date. Medicare contractors will initiate overpayment recovery procedures to recoup any Medicare Part A and Part B payments.