US · guidance
CMS Pub. 100-09, ch. 6, § 20.2.3
Provider Inquiry Analysis
MACs shall establish and maintain a systematic approach to analyzing provider inquiries
identifying common areas of confusion or misunderstanding. This analysis enables MACs to
develop proactive educational interventions that address recurring issues before they result in
claim errors. By implementing a comprehensive inquiry analysis program, MACs can transform
reactive customer service into proactive education that prevents problems at their source.
MACs shall maintain a provider inquiry analysis program that generates monthly reports of
frequently asked questions (FAQs) that indicate systemic knowledge gaps. MACs shall use
CMS-approved classification systems for categorizing inquiries to ensure consistency across
jurisdictions and enable meaningful trend analysis. Based on identified patterns, MACs shall
develop targeted education that directly addresses provider needs and knowledge gaps revealed
through the inquiry data. Additionally, MACs shall create comprehensive training programs for
PCSP staff based on inquiry trends to ensure staff can effectively address common provider
concerns and provide accurate guidance.
History
(Rev. 13683; Issued: 04-08-26; Effective: 05-08-26; Implementation: 05-08-26)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
dbc5850db6003711036afcafebfca69b09eb149299f91e8b684b4b437dd68522
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