CMS Pub. 100-04, ch. 27, § 40.1

This section applies only to MACs; it does not apply to providers.

In the normal course of claims processing activities, MACs can expect to encounter

problems involving the CWF Claim Record and/or basic reply record procedures. The

action necessary to resolve the problem depends upon the problem identified. For

utilization problems and/or HICR requests, the MAC enters the issue into the secure

online inquiry system, Host Request Inquiry (HURQ), provided by the CWF Host, and

sends all master beneficiary, summary history, and inpatient summary history screen-

prints for the beneficiary to the CWF HICR contractor for investigation. The MAC takes

the following steps:

• Put the error code causing the problem in the upper right-hand corner of the

Beneficiary Master screen print;

• Mark on all of the screen prints exactly what the problem is and what is believed

to be the correction needed;

• The MAC (contractor) sends these marked screen prints to the CWF HICR

contractor. They coordinate with the other contractor to determine who needs to

correct the problem; and

• The CWF HICR contractor will investigate the problem and correct it. If a

response is not received within 45 days of mailing the request for assistance, the

contractor sends a second request marked "SECOND REQUEST."

NOTE: Congressional requests are faxed to the CWF HICR contractor. Faxes must be

reviewed and corrective action taken within 24-48 hours of receipt.

For problems involving the Host CWF Site, the MAC utilizes the HICR transaction. This

transaction provides the Host CWF site a method of creating transactions that correct the

local database.