CMS Pub. 100-04, ch. 29, § 270.2.8

If any one of the elements is missing from the CMS-20031, the MAC shall contact the party and provide a

description of the missing documentation or information. If the defect is not cured, the prospective assignee

of appeal rights lacks the authority to act on behalf of the party, and is not entitled to obtain or receive any

information related to the appeal, including the appeal decision.

The MAC shall provide help and assistance to the beneficiary and provider or supplier in securing the

transfer of appeal rights, based on the time frames set forth below.

A. Timely Filed Appeal Request with a Defective Transfer of Appeal Rights

When an incomplete or defective transfer of appeal rights form is received , the MAC shall notify both the

provider/supplier submitting the CMS-20031 and the beneficiary. The MAC shall advise them why the

transfer is defective, and describe the missing information that is required to complete the transfer. This

may be done by telephone or written notification. The method, time and date of any notification shall be

documented in the case file. A corrected/completed transfer may be submitted to the MAC by mail, or at the

MAC’s discretion, by facsimile or a secure Internet portal/application, within 14 days. Should the CMS-

20031 not be corrected within this time limit, the MAC proceeds with processing and rendering a decision

on the appeal. It sends the appeal decision to the beneficiary and any other party to the appeal, but not to the

unauthorized assignee. This will ensure that the beneficiary receives an appeal, as the presumption here is

that the appeal originated with the beneficiary and was submitted with the beneficiary’s knowledge and

consent. However, if the MAC has information or evidence that the transfer was not submitted at the

request of the beneficiary, it shall not conduct the appeal unless and/or until it receives confirmation from

the beneficiary that the request was submitted with the beneficiary’s approval.

B. Untimely Appeal Request Submitted With an Incomplete or Defective Transfer

Because an untimely-filed appeal request is not always dismissed (e.g., there could be the finding of good

cause for late filing, see §240.1), an incomplete or defective CMS-20031 may, in some cases, need to be

corrected. If an incomplete or defective CMS-20031 needs to be corrected, the MAC shall follow the

instructions contained in Section A above, prior to proceeding with the appeal request.

C. Untimely Appeal Request Submitted With a Valid Transfer

These cases should be resolved solely on the basis of whether there is good cause. (See §240.1.)