CMS Pub. 100-09, ch. 6, § 30.7.4.2

MACs may respond to general provider and PRRS provider written inquiries by telephone within 45

business days of receipt. MACs shall use their discretion when identifying which provider written

inquiries (for example, provider correspondence that requires a general response) can be responded to

by telephone.

For tracking and evaluation purposes, MACs shall develop a report of contact for each telephone

response to a provider written inquiry and retain these reports in the same manner and time frame as

written responses. All reports of contact shall contain the following information:

• Provider name (including the representative or billing company name when applicable)

• Provider telephone number

• Provider number (NPI or Provider Transaction Access Number (PTAN))

• Date of contact

• Internal inquiry control number

• Subject/nature of inquiry

• Summary of discussion

• Status: closed, pending research, open

• Follow-up action required (if any)

• Name of the written CSR who handled the inquiry

When a provider requests a copy of the report of contact, the MAC shall send a response letter containing

all the information in the “Summary of Discussion” section of the report of contact. If the provider

requests an email or fax response, MACs shall follow the requirements in section 30.6 of this chapter

when the response contains protected or sensitive information like PII Or PHI. Sending the report of

contact isn’t acceptable. All timeliness and quality guidelines for a written response apply to the response

sent.

If the MAC can’t reach the provider by telephone, the MAC shall develop a written response within 45

business days of receipt of the incoming inquiry. Leaving a message/response on the provider’s

voicemail isn’t acceptable.