CP2
Validation
Also listed under Program Integrity.
CMS-required outcome
The system performs comprehensive validation of claims and claims adjustments, including validity of services.
Default metrics
- Count/percentage of claims/claims adjustments accepted/suspended/rejected for processing.
Regulatory sources
- 42 CFR 431.052(published as 431.052; resolves to 431.52)
- 42 CFR 431.055(published as 431.055; resolves to 431.55)
- 42 CFR 447.26
- 42 CFR 447.45(f)
- 45 CFR 162.1002
- SMD Letter 10-017
- SMM Part 11 Section 11300