MAs, MA-PDs, and PDPs:
Click here for retroactive SOPs and submission process
IntegriGuard conducts prepayment review on proposed retroactive enrollment adjustments for the state and county codes and the special status categories of institutional, Medicaid, and End Stage Renal Disease (ESRD). After conducting prepayment review, IntegriGuard processes the adjustment into the McCoy system.
This page is designed to provide a reference for Medicare Advantage (MA) Organizations, formerly known as Medicare+Choice Organizations (M+CO) to submit Retroactive Payment Adjustment requests to IntegriGuard.
Submission of Retroactive Requests
Medicare Advantage Organizations may submit retroactive requests electronically. An Excel spreadsheet has been developed for each category using Visual Basic code to assist you in making sure that the data is submitted in the appropriate format. In order to take advantage of this process, please register to receive the tool kit ...
Other Means of Submittal
Data may also be submitted to IntegriGuard on CD or diskette. The format and required fields are shown under each status category listed below. It is very important that all elements listed are provided in the format requested. This is particularly important when submissions are processed electronically.
As part of the system implemented to process these adjustments, IntegriGuard has developed a procedure by which a MA Organization may ask IntegriGuard to reconsider determinations that are made.
Standard Operating Procedures
IntegriGuard will follow the Standard Operating Procedures (SOPs) that are in place at Centers for Medicare & Medicaid Services (CMS) for the completion of all retroactive adjustments.