Retention Date: June 15, 2026
A. Purpose
The purpose of this emergency message (EM) is to notify Field Offices (FO) and Workload Support Units (WSU) that Technology Assisted Adjudication (TAA) was released for standard Medicare-only internet claims (iClaims), on December 13, 2025.
B. Background
Previously, Medicare-only iClaims were processed via the Automated Medicare Processing (AMP) application or routed to technicians for review and adjudication through the Modernized Claims System (MCS).
Effective December 13, 2025, TAA will identify “standard” Medicare-only iClaims and process them to completion without any technician intervention in the Consolidated Claims Experience (CCE) system. IClaim applications that do not meet “standard” criteria will be routed to technicians for review and adjudication in MCS or CCE. The criteria for “standard” cases is outlined in section C of this EM.
TAA will automate the processing of standard Medicare-only internet claims (iClaims) by:
· Evaluating the claim to identify discrepancies or edits.
· Checking internal records, including information obtained from Centers for Medicare and Medicaid Services (CMS) data exchanges.
· Identifying policy exclusions and processing limitations, therefore alerting management that technician action is required.
· Generating issues on the Development Worksheet (DWS) in CCE to alert the technician of items that may require additional development (i.e., unauthenticated claims, citizenship, and record discrepancies).
· Routing claims that do meet the standard criteria to the appropriate office for further development in the CCE or MCS.
· Adjudicating standard Medicare-iClaims to completion. CCE will then establish the MBR.
C. Scope and Limitations
TAA currently has a limited scope and can only complete processing of a claim that meets the standard criteria. For TAA, standard criteria is defined as a claimant who is:
· A U.S. Citizen by birth (not Naturalized citizens) with age and citizenship proven (or tolerance applicable)
· Within the first 3 months of their Initial Enrollment Period (IEP) prior to attainment of age 65
· Filing for Medicare only
· Filing for themselves on their own record
· Residing in the US with a domestic mailing address
· Selecting English as their preferred written and spoken language
· Fully insured (40 Social Security QCs for Medicare on own record, no Foreign QCs used for insured status)
· Not receiving Medicaid
· Filing for the first time, with no prior:
o MCS segment (active, closed, or deleted),
o iClaim (partial, pending, or completed),
o MBR (under own or someone else’s SSN), or
o Supplement Security Record (SSR) (under their own SSN)
D. Functionality
After TAA successfully processes the Medicare application via CCE, a technician can view:
· The processed claim and development screens in CCE
o The unit code should reflect CCETAA
· The Notice of Award, as well as a copy of the internet application, stored in ORS
· Medicare enrollment information on the MBR or HI/SMI Query Response (HIQR) screen to verify:
o Medicare start dates
o Billing information
o Medicare card issuance
Claims that cannot be processed through TAA will be routed to the WSU/FO of jurisdiction and are accessible in WAC. These claims will be located in two separate folders; Pending Claims and Internet Claims.
IMPORTANT: Offices will need to access the claims in both locations for technician assignment and review.
E. Locating Actionable Claims
Pending Claims
Claims that are unable to be adjudicated by TAA but have successfully been loaded in CCE do not need to be imported. These claims will show on the WAC T2 Pending list with the unit code CCETAA, and a “1” indicator in the MCS column to indicate the claim is located in CCE.
IMPORTANT: Once the claim has been assigned to a technician for review and processing, the unit code should be changed to the typical unit code utilized in the office of jurisdiction.
These claims will also have an open Development Worksheet issue of “TAA Claim” which will need to be receipted in upon completion of all outstanding development of the claim.
Internet Claims
Internet claims that cannot be processed via TAA or CCE will continue to be imported to MCS through normal WAC procedures into MCS. Offices should follow normal processes for importing and assigning cases for review and processing.
F. Processing Reminders
Technicians should follow normal procedures to review and adjudicate the claims that cannot be processed through TAA in CCE and MCS. See GN 00204.059 and GN 01010.008 for technician adjudication responsibilities.
Direct all program-related and technical questions to vHelp, FO management or Program Service Center (PSC) Operations Analysis (OA) staff. PSC OA staff may refer questions, concerns or problems to their Central Office contacts.
Reference:
GN 00204.059 – Internet Claim (iClaim) Medicare-only Application
GN 01010.008 - Field Office (FO) Adjudicative Responsibilities
MSS25-210 OTH - Technology Assisted Adjudication (TAA) - Medicare Internet Claims (iClaims) Release
Consolidated Claims Experience (CCE) User Guide
WAC User Guide