US · guidance
CMS Pub. 100-09, ch. 2, § 20.2.2
Controlling Complex Beneficiary Inquiries
The MACs shall control all complex beneficiary inquiries until they are closed by the
PRRS. NGD will be maintained with accurate information so that if the beneficiary calls
the BCC for information related to the initial inquiry, the BCC can address status and
outcome and determine if additional follow up is necessary.
Unless they meet the exception for second level Benefit Integrity escalations described in
section 20.1.3, inquiries referred to other MAC departments by the PRRS may close the
inquiry in NGD as long as accurate and reliable information is documented in the
resolution details field, including the nature of referral (e.g., appeals, MSP, etc.).
History
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e341d539a33bac2c64eda3691c41a4c8845998833773a080cc144731cee62d7d
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