UM Operations
Carve-Out
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Carve-outs are why "where do I send this authorization?" has no single answer for some members, and why AAA 95-style rejections (eligible, but not for this benefit here) occur. In Medicaid, state-level carve-outs add a further layer: some services are authorized by the state or its vendor, not the MCO.