US · guidance
CMS Pub. 100-09, ch. 6, § 70.2.2.2
Timeliness of Responses to Complex Provider Inquiries
The PRRS staff shall provide clear and accurate answers to provider inquiries within 45 business days of
receipt.
This timeframe starts the day the MAC originally receives and date-stamps the inquiry and ends the day
the MAC sends the final response. For those PRRS inquiries that can’t be answered in final within 45
business days of receipt, MACs shall issue an interim response acknowledging receipt of the inquiry
and explaining the reason for the delay. When possible, inform the provider about how long it will be
until a final response will be sent. Sending an interim response doesn’t resolve the issue and the inquiry
isn’t considered closed until the MAC sends the final response. The final response shall be sent within 5
business days after receipt of the needed information. Any interim responses sent to PRRS inquiries will
count toward the MAC’s overall allowance of no more than 5 percent of interim responses for the
universe of written responses to provider inquiries.
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
d1acd1269599ff4ea8af07b27aeffe5247b48b2b139b19012a48467fef782542
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