CMS Unified Case Management (UCM) NexGen

The purpose of the UCM system is to improve prevention and detection of fraud, waste, and abuse in Medicare and Medicaid program spending. CMS began transitioning PSCs and UPICs to Unified Program Integrity Contractors (UPICs) in 2016. As a result, CMS and the PI Contractors were able to share best practices across UPIC referred overpayments, identify strategies to increase MACs collection of UPIC referred overpayments, work with the MACs to create a standard report format both for overpayment referral reports and overpayment collection reports, and institute the use of a unique identifier for each overpayment. The UCM system consolidated several individual PSC and ZPIC systems into one centrally located system which CMS oversees and manages, which improved and enhanced the management and oversight of the PI contractors, resulting in benefits across all areas of PI. This enhancement provides direct and transparent access to the program integrity workflow, as well as promotes coordination and efficiency across the lifecycle of a case. The project implemented the functionality of the UCM system by analyzing and reviewing current systems used by CMS contractors and migrated functionality and data into UCM. Several information management systems supported CMS PI activities by tracking investigations and the workload of PI contractors who investigate allegations of suspected fraud, waste, or abuse (FWA). Prior to the UCM, a number of PI contractors maintained their own standalone proprietary case tracking systems to track their workload and produce reports. There were also two CMS owned contractor operated systems Fraud Investigation Database (FID) and the Work Flow Management System (WFMS). Through the implementation of UCM, CMS has been successfully able to limit the use and oversight for FWA activities to a single system.

• Total
• Cost Pools