Database of ALJ/MAC decisions
Benefit Type (required - results will not display if left blank)	choose one Part A Hospice Part A or C Skilled Nursing Facility Part A, B or C Ambulance Part A, B or C Home Health Part A, B or C Inpatient Hospital Services Part B or C Durable Medical Equipment (DME) Part B or C Other Part D Prescription Drug	___	Results will be sorted by date, newest to oldest, in groups of 10, with a maximum return of 200. Use "<" and ">" to scroll back and forth through the lists. NOTES: Cases with multiple issues may appear multiple times in your search.  Also, the links that are returned will open large .pdf files which may take a moment to download, and which require the Adobe Reader® to view.  If you do not already have the Reader installed, download it here.
Issue 1 (required - results will not display if left blank)	choose one Merit - As a Practical Matter in SNF Merit - Complexity Requires Services Provided by Skilled Personnel Merit - Dental Services Merit - Dependant Services Merit - End of Life Care/Comfort Measures Merit - Frequency of Skilled Services Merit - Homebound Status Merit - Improvement Standard Merit - Least Expensive Care Setting Actually Available Merit - Management of Care Plan Merit - Medical Reasonableness and Necessity Merit - National or Local Coverage Determination (NCD or LCD) Merit - Observation and Assessment Merit - Observation Status Hospitalization Merit - Origin/Destination Requirements Merit - Patient Education Services Merit - Per Se Skilled Services Merit - Physician's Orders Merit - Related to Hospitalization or Condition Which Arose Merit - Skilled Rehabilitation Services Merit - Total Condition Other - Other Part A or B Liability - Advance Beneficiary Notice Defective Part A or B Liability - Advance Beneficiary Notice Delivered Late Part A or B Liability - Authority of Notice Recipient to Act as Bene.'s Representative Part A or B Liability - Capable Recipient of Notice Part A or B Liability - Language Barrier to Notice Comprehension Part A or B Liability - No Advance Beneficiary Notice Given Part A or B Liability - Telephone Notice Part C Liability - Authority of Notice Recipient to Act as Bene.'s Representative Part C Liability - Capable Recipient of Notice Part C Liability - Language Barrier to Notice Comprehension Part C Liability - No Notice Given Part C Liability - Notice Defective Part C Liability - Notice Delivered Late Part C Liability - Telephone Notice Part D - Non-Formulary Drugs Part D - Off-Label Use of Drugs Part D - Prior Authorization Part D - Quantity Limit Part D - Step Therapy Requirements Procedure - Procedural issues Technical - 3 Day Hospital Stay Technical - Benefits Exhausted Technical - Physician Certification/Recertification
Issue 2 (optional)	choose one Merit - As a Practical Matter in SNF Merit - Complexity Requires Services Provided by Skilled Personnel Merit - Dental Services Merit - Dependant Services Merit - End of Life Care/Comfort Measures Merit - Frequency of Skilled Services Merit - Homebound Status Merit - Improvement Standard Merit - Least Expensive Care Setting Actually Available Merit - Management of Care Plan Merit - Medical Reasonableness and Necessity Merit - National or Local Coverage Determination (NCD or LCD) Merit - Observation and Assessment Merit - Observation Status Hospitalization Merit - Origin/Destination Requirements Merit - Patient Education Services Merit - Per Se Skilled Services Merit - Physician's Orders Merit - Related to Hospitalization or Condition Which Arose Merit - Skilled Rehabilitation Services Merit - Total Condition Other - Other Part A or B Liability - Advance Beneficiary Notice Defective Part A or B Liability - Advance Beneficiary Notice Delivered Late Part A or B Liability - Authority of Notice Recipient to Act as Bene.'s Representative Part A or B Liability - Capable Recipient of Notice Part A or B Liability - Language Barrier to Notice Comprehension Part A or B Liability - No Advance Beneficiary Notice Given Part A or B Liability - Telephone Notice Part C Liability - Authority of Notice Recipient to Act as Bene.'s Representative Part C Liability - Capable Recipient of Notice Part C Liability - Language Barrier to Notice Comprehension Part C Liability - No Notice Given Part C Liability - Notice Defective Part C Liability - Notice Delivered Late Part C Liability - Telephone Notice Part D - Non-Formulary Drugs Part D - Off-Label Use of Drugs Part D - Prior Authorization Part D - Quantity Limit Part D - Step Therapy Requirements Procedure - Procedural issues Technical - 3 Day Hospital Stay Technical - Benefits Exhausted Technical - Physician Certification/Recertification
Issue 3 (optional)	choose one Merit - As a Practical Matter in SNF Merit - Complexity Requires Services Provided by Skilled Personnel Merit - Dental Services Merit - Dependant Services Merit - End of Life Care/Comfort Measures Merit - Frequency of Skilled Services Merit - Homebound Status Merit - Improvement Standard Merit - Least Expensive Care Setting Actually Available Merit - Management of Care Plan Merit - Medical Reasonableness and Necessity Merit - National or Local Coverage Determination (NCD or LCD) Merit - Observation and Assessment Merit - Observation Status Hospitalization Merit - Origin/Destination Requirements Merit - Patient Education Services Merit - Per Se Skilled Services Merit - Physician's Orders Merit - Related to Hospitalization or Condition Which Arose Merit - Skilled Rehabilitation Services Merit - Total Condition Other - Other Part A or B Liability - Advance Beneficiary Notice Defective Part A or B Liability - Advance Beneficiary Notice Delivered Late Part A or B Liability - Authority of Notice Recipient to Act as Bene.'s Representative Part A or B Liability - Capable Recipient of Notice Part A or B Liability - Language Barrier to Notice Comprehension Part A or B Liability - No Advance Beneficiary Notice Given Part A or B Liability - Telephone Notice Part C Liability - Authority of Notice Recipient to Act as Bene.'s Representative Part C Liability - Capable Recipient of Notice Part C Liability - Language Barrier to Notice Comprehension Part C Liability - No Notice Given Part C Liability - Notice Defective Part C Liability - Notice Delivered Late Part C Liability - Telephone Notice Part D - Non-Formulary Drugs Part D - Off-Label Use of Drugs Part D - Prior Authorization Part D - Quantity Limit Part D - Step Therapy Requirements Procedure - Procedural issues Technical - 3 Day Hospital Stay Technical - Benefits Exhausted Technical - Physician Certification/Recertification

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_Decision_ _Date_	_Issue_1_	_Issue_2_	_Issue_3_	_Benefit_ _Type_	_Decision_ _Type_	_Decision_ _Level_	_ALJ_ _Name_	_Filepath_
No results match these criteria. Please feel free to submit any decisions you feel would add value to our database. Contact Alfred Chiplin in our Washington, DC office.
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