How Will I Know When a Payment Determination Has Been Issued?

When a Recovery Auditor finds that improper payments have been made, they will submit claim adjustments to your MAC. The MAC will perform the adjustments based on the Recovery Auditor’s review, and issue an automated demand letter to the provider. If you agree with the Recovery Auditor's determination, National Government Services will issue the recoupment offset on your remittance advice (unless you have submitted a check or a valid appeal). Recovery Auditor recoupment offsets will be identified on your remittance advice with the following ANSI remark code and message:

N432: Adjustment based on recovery audit

Reviewed 4/29/2024