RACManager

The RAC Audit process mirrors the Medicare appeals process. RACManager automatically directs your claims to the appropriate appeal level based upon user activity. This eliminates the complexity of managing a multi-layered appeal process.

When you are first notified (Demand Letter) that money will be taken back, RACManager will automatically transfer the claim to the MAC Level so that you can make the first appeal decision.

If you win your appeal, the claim will be automatically removed from that MAC Level but it will remain available for reporting and review. If you lose your appeal, RACManager will automatically transfer the claim to the QIC Level so that you can make the next appeal decision. This ‘flow’ continues through all appeal levels or until you decide to not appeal any further.

Auto Flow works with the Alert Assistant. The Alert Assistant automatically informs your team in the daily email summary only when claims have changed appeal levels. This means that Team Members do not need to login to RACManager every day to know what is happening.