US · guidance
CMS Pub. 100-04, ch. 30, § 260.4.4
Provider Responsibilities
When a provider is notified by a QIO of a beneficiary request for an expedited
determination, the provider must:
• Deliver the beneficiary a DENC (see §260.4.5) by close of business the day they
are notified;
• Supply the QIO with copies of the NOMNC and DENCs by close of business of
the day of the QIO notification;
• Supply all information, including medical records, requested by the QIO. The
QIO may allow this required information to be supplied via phone, writing, or
electronically. If supplied via phone, the provider must keep a written record of
the information it provides within the patient record; and
Furnish the beneficiary, at their request, with access to or copies of any documentation it
provides to the QIO. The provider may charge the beneficiary a reasonable amount to
cover the costs of duplicating and delivering the documentation. This documentation
must be provided to the beneficiary by close of business of the first day after the material
is requested.
History
(Rev. 2711, Issued: 05-24-13, Effective: 08-26-13, Implementation: 08-26-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e7d1d81516227a727fb4c72e4dccb755f7ed223770da557d7bea672ae03bbe59
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