CMS Pub. 100-06, ch. 7, § 50.3

C – Control

Number

Control Objective – Appeals

C.1 Medicare Part A and Part B redeterminations processed by MACs

are processed based on CMS instructions, appropriately logged and

completed within legislatively mandated time frames and tracked to

meet CMS guidelines. (Does not pertain to MSPRC. Refer to C.3

for MSPRC control objective.)

C.2 Medicare Part B redeterminations processed by MACs are

processed based on CMS instructions, appropriately logged and

completed within legislatively mandated time frames and tracked to

meet CMS guidelines. (Does not pertain to MSPRC. Refer to C.3

for MSPRC control objective.)

C.3 Redeterminations processed by the MSPRC are processed based on

CMS instructions, appropriately logged and completed within

legislatively mandated time frames and tracked to meet CMS

guidelines.

C.4 Qualified Independent Contractor (QIC) request for case files are

handled in compliance with CMS time frames.

C.5 Effectuations are processed as directed by CMS guidelines.

C.6 Contractor communications are clear and in compliance with CMS’

instructions to include specific communications such as

acknowledgement letters, decision letters, and information on

additional appeal rights, etc.

End Section 50.3 – C Controls – Appeals: Back to Table of Contents