CMS Pub. 100-04, ch. 1, § 70.8.6.3

Claim submission violations need not be developed on beneficiary-submitted Form CMS-

1490S claims that include approved charges for services performed on or after September

1, 1990 in the following situations:

o Used DME purchases from private sources;

o Cases in which a physician/supplier does not possess information essential

for filing a MSP claim. Assume this is the case if the beneficiary files a MSP claim and

encloses the primary insurer's payment determination notice and there is no indication that

the service provider was asked to file but refused to do so;

o Services paid under the indirect payment procedure;

o Foreign claims; and

o Other unusual or unique situations that you evaluate on a case-by-case basis.

NOTE: It is unlikely that knowing, willful, and repeated noncompliance will apply in

the above situations.