CMS Pub. 100-09, ch. 6, § 30.7

MACs shall handle written inquiries received by postal mail, email, fax or secure internet portal

consistently to ensure accuracy, professionalism and timeliness. Each inquiry requires a final response

in the language of the incoming inquiry that accurately and completely addresses all issues raised in the

incoming inquiry. For inquiries that could be resolved through self-service options (such as claim

status and eligibility inquiries), MACs shall direct providers to the appropriate self-service resources.

MACs should encourage providers to use their MAC secure internet portal when such functionality

exists. Additionally, responses should include information about relevant educational opportunities on

the MAC’s provider education website, when appropriate to the inquiry topic.

MACs handle the following three types of provider written inquiries:

1. General – Provider written inquiries handled within the PCC that don’t require extra

research. They shall meet the performance standards in this section and the timeliness

standards defined in section 70.2.2.1 of this chapter.

2. PRRS – Provider written inquiries handled within the PCC that require extra research,

can’t be handled by the general inquiries staff, or are sensitive or complex in nature,

excluding Congressionals. PRRS inquiries also include all beneficiary inquiries

referred to the MAC from Call Center Operations (CCO). See chapter 2 of this manual

for information about beneficiary written inquiries. All PRRS provider written

inquiries shall meet the performance standards in this section and the timeliness

standards defined in section 70.2.2.2 of this chapter.

3. Congressional – Provider written inquiries the MAC receives either directly from a

Congressional office through CMS Central Office or a CMS Regional Office.

Congressional provider written inquiries shall meet the performance standards in

this section and the timeliness standards defined in section 70.2.2.4 of this chapter.

If written responses to provider inquiries contain sensitive or protected information, such as PHI

or PII, MACs shall apply reasonable safeguards in responding to protect that information from

inappropriate use or disclosure. See section 30.7.4.3 of this chapter regarding specific

requirements for electronic responses to provider inquiries.