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HMS welcomes you to RAC-Info!

Important Provider Updates

7/20/2020:   CMS COVID-19 Provider Burden Frequently Asked Questions
HMS remains committed to supporting CMS’ program integrity medical review activities.  Per CMS’ guidance, HMS will begin contacting providers to schedule postponed Discussion Period Peer-to-Peer teleconferences.  Additional review activity will resume upon CMS approval.  Providers are encouraged to monitor CMS’ site for updates on the 2019-Novel Coronavirus (COVID-19) public health emergency (PHE) and the new Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs):   Questions regarding the FAQ should be directed to

3/24/2020:   COVID-19 Information:

As we all continue to navigate the rapidly evolving COVID-19 situation, HMS remains available and is here to help. HMS is committed to providing the most current and up-to-date statuses for all reviews currently in progress, under CMS’ approved review guidelines.  Please continue to monitor the provider portal ( or contact the Provider Relations Department via email at: or telephone at (877) 350-7992 (Part A) or (877) 350-7993 (Part B), should you have any questions regarding the status of your reviews. Above all, stay safe and healthy.

8/12/2019:   HMS RAC 4 & Noridian JE/JF MAC Web-based Workshop

To educate providers on the RAC Process, HMS will partner with the Noridian JE/JF Medicare Administrative Contractor (MAC) to host a Part A and Part B Webinar on 9/12/2019 from 11:00 am – 12:00 pm Pacific Daylight Time. 

The Webinar will provide an overview of:

  • Review Types Performed
  • Medical Record Submission
  • Approved New Issues
  • Discussion Period Process
  • RAC 4 Provider Portal
  • HMS Contact Information
  • Reminders and Resources
  • Noridian’s Role in the RAC Process

All registrations must be completed online via the following link:

Experiencing trouble accessing the Link?  Contact the Noridian JE/JF MAC Customer Service Department for assistance.

JE Part A/B: 855-609-9960
JF Part A/B: 877-908-8431

5/1/2019:   CMS Referrals for Approved RAC Topics
CMS often receives referrals of potential improper payments from the MACs, UPICs, and Federal investigative agencies (e.g., OIG, DOJ). At CMS discretion, CMS may require the RAC to review claims, based on these referrals. These CMS-Required RAC reviews are conducted outside of the established ADR limits.  Please refer to the CMS website for additional information on approved RAC Topics.

3/8/2019:   MS-DRG Comprehensive Coding Reviews

The Recovery Auditor is required to perform a Comprehensive Coding Review of all MS-DRG Coding claims for which an improper payment is identified, rather than a review which focuses only on code changes which impact the original DRG Code billed and paid.  Review Outcome Letters have been enhanced to include the outcome of the Comprehensive Coding Review including all additional code changes, which may not impact the DRG assignment.  The Comprehensive Coding Review does not change or impact a provider’s right to file a discussion period review with HMS, within 30-days from the date of the Review Outcome Letter, for those code changes which impact DRG assignment. Upon completion of the discussion period review resulting in an upheld decision or after the 30-day discussion period, if no discussion period request was filed, claims will be submitted to the MAC for adjustment, reflecting the code changes outlined in the Review Outcome Letter.

5/17/2018:   Medicare Beneficiary Identifier (MBI) replacing Health Insurance Claim Number (HICN)

Effective April 2018, CMS is removing Social Security Numbers (SSNs) from all Medicare cards. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. 

Providers can obtain access to the MBI by 1) Ask your Medicare Patient for their new Medicare Card 2) Use the Medicare Administrative Contractors’ (MAC) secure MBI lookup tool 3) Check the remittance advice.

As mandated by CMS, all HMS RAC 4 written communication will be updated to include the MBI.  The HICN will eventually be phased out and removed from all communication.  The MBI is confidential like the SSN and should be protected as Personally Identifiable Information.

Additional information on the new Medicare Cards may be found on the CMS website.  You may also contact your Medicare Administrative Contractor (MAC) with questions regarding Medicare claims submission requirements.

5/8/2018:   Removal of Prohibition of Recovery Audit Contractor (RAC) Reviews of Periodic Interim Payment (PIP) Providers
“Medicare FFS Recovery Audit Contractors (RACs) are approved by CMS to review Periodic Interim Payment (PIP) Providers under CMS New Issue #0001 MS-DRG Validation. Facilities receiving Periodic Interim Payments (PIP) will receive ADRs within 6 months of the date of service for claims under review.”

4/30/2018:   HMS RAC 4 Skilled Nursing Facility (SNF) Audits - Hold Released

The hold on all SNF reviews was released effective 4/30/2018.  All reviews will be completed by 6/28/2018.  As the reviews are completed, a review results letter will be issued providing the outcome of the review.  Please continue to monitor the Region 4 Provider portal for the status of the reviews.

4/20/2018:   HMS RAC 4 Skilled Nursing Facility (SNF) Audits

As approved by CMS, all Region 4 Skilled Nursing Facility (SNF) Complex Reviews are temporarily on hold.  CMS has granted HMS an extension to perform the reviews after the hold is released.   Providers are still required to follow the medical record submission timeframes outlined in the Additional Documentation Request Letter. 

Please continue to monitor the Region 4 Provider Portal for updates on when the hold is released. We appreciate your patience during the review period.

2/6/2018:   Refund Checks for RAC Identified Improper Payments

Refund checks for RAC Identified Improper Payments should not be sent to the RAC or the Medicare Administrative Contractor (MAC) upon receipt of the Informational Letters for an automated review, Review Results Letter for a complex review or the discussion period review outcome letter.  Instead, Providers should wait to receive a demand letter, from the MAC, which identifies the improper payment amount and outlines repayment options.


As a reminder, refund checks should never be sent to the RAC, but can be submitted to your MAC, after you receive a demand letter.

7/5/2017:   HMS Provider Portal Contact Customization

The HMS Provider Portal is available for all Region 4 Providers in the JL, JE and JF MAC Regions to customize their contact information. Provider Portal User Guides are available on the homepage, under Links and Resources, to assist Providers with establishing their user credentials and customizing their contact information. Providers may also contact HMS' Provider Relations Department for assistance. 

HMS has received CMS approval to initiate review in the Novitas JL MAC Region.

5/18/2017:   RAC 4 Audits
HMS Region 4 RAC has received CMS approval to begin audits for the Noridian JE and JF MAC Part A and Part B Jurisdiction.

5/15/2017:   Provider Outreach Presentations
The HMS Region 4 Part A and Part B Provider Outreach Presentations are now located under the "Links & Resourcces" on the home page. 

Please continue to monitor the Provider Portal for updates on when HMS will initiate reviews in Region 4.

4/12/2017:   HMS Awarded Region 4 Recovery Audit Contract
On October 31st, 2016, CMS awarded HMS Federal Solutions (HMS), a wholly owned subsidiary of HMS Holdings Corporation, the Region 4 Recovery Audit Contractor (RAC) contract. As the Region 4 RAC, HMS will perform postpayment reviews to identify improper payments (overpayment and underpayments) that were made on all Part A and Part B Medicare claims for all provider types. Additional updates related to Region 4 RAC reviews will be posted to this website as HMS implements the RAC Program in Region 4. 

Please refer to the following link for the map of the Medicare Fee-for-Service RAC Regions and related RACS. Medicare Fee-for-Service RAC Region Map Selecting this link will open a new window.

CMS recent updates on the RAC Program may be found at: CMS recent updates on the RAC Program may be found at: Selecting this link will open a new window.

  Note: Both HMS Federal Solutions and HealthDataInsights (HDI) are wholly owned subsidiaries of HMS Holdings Corporation.
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