CMS Pub. 100-04, ch. 27, § 50.1

The requesting A/B MAC or DME MAC furnishes the assisting A/B MAC or DME MAC

with sufficient information to identify the issue and perform the necessary resolution

actions. The data shown on the Request for Assistance Form (see Exhibit 1) is needed.

This format must be used when designing a form letter so that both the requesting A/B

MAC or DME MAC's address and the assisting A/B MAC or DME MAC's address will be

visible through a window envelope. A separate page is used for each request to enable

the assisting A/B MAC or DME MAC to return each claim as completed instead of

holding claims until all claims on a request are completed. The requesting A/B MAC or

DME MAC enters its request after "The following action is requested." The requesting

A/B MAC or DME MAC provides claim-identifying information as shown. The

requesting A/B MAC or DME MAC adds information to help it associate the response

with its pending record, if needed.

If a response has not been received within 30 calendar days of the request, the requesting

A/ B MAC or DME MAC sends a follow-up request. If no response is received within an

additional 15 days, follow-up with the RO responsible for the assisting A/B MAC or DME

MAC. A status report indicating and defining problems that prevent processing of the

request is considered a response in deciding whether to follow-up with the RO.

In addition, the requesting A/B MAC or DME MAC considers whether an interim

payment to the provider without CWF approval is appropriate. (See §60 of this chapter

for procedures for paying without CWF approval.)