CMS Pub. 100-08, ch. 10, § 10.7.2

A. Development Letter Guidance

In the following sentence:

“Please submit the requested revisions and/or supporting documentation preferably within [xx]

calendar days of the postmarked date of this letter to the address listed below:”

The value in “xx” may be from 7 to 30.

Note: Items such as checklists and documents may be attached to the letter.

B. Model Development Letters

Example

[month] [day], [year]

[Provider/Supplier Name]

[Address]

[City] ST [Zip]

Reference # (PTAN #, Enrollment #, Case #, etc.)

Dear [Provider/Supplier Name]:

We have received your Medicare enrollment application(s). We may reject your application(s) if

you do not furnish complete information within 30 calendar days from the postmarked date of

this letter pursuant to 42 CFR §424.525. In order to complete processing your application(s),

please make the following revisions and/or supply the requested supporting documentation:

[Specify revisions and/or supporting documentation needed]

[If the application was submitted via paper, use the following language:

“Please submit the requested revisions and/or supporting documentation within [xx] days of the

postmarked date of this letter to the address listed below:

[Name of MAC]

[Address]

[City], ST [Zip]

Finally, please attach a copy of this letter with your revised application(s).”]

[If the application was submitted via PECOS, use the following language:

“Please submit the requested revisions and/or supporting documentation via PECOS within [xx]

days of the date on this letter.”].

If you have any questions, please contact our office at [phone number] between the hours of

[x:00 AM/PM] and [x:00 AM/PM.

Sincerely,

[Name]

[Title]

[Company]