US · guidance
CMS Pub. 100-18, ch. 12, § 20.15
Beneficiary Customer Service Call Center Requirements
CMS has granted a waiver of the Part D beneficiary customer service call center hour
requirements for all Direct Contract and “800 series” EGWPs offered by PDP sponsors. See
Addendum 2 - Customer Service Call Center Requirements of the Medicare Marketing
Guidelines (as revised 7/25/06). These entities will be allowed to operate beneficiary
customer service call center hours for their employer/union group health plan only enrollees
that differ from the Part D requirements for plans offered to individual beneficiaries. These
entities must ensure that a sufficient mechanism is available to respond to beneficiary
inquiries and must provide customer service call center services to these Part D eligibles
during normal business hours. However, CMS may review the adequacy of these call center
hours and potentially require expanded beneficiary customer service call center hours in the
event of beneficiary complaints or for other reasons in order to ensure that the entity’s
customer service call center hours are sufficient to meet the needs of its enrollee population.
Also, CMS has granted a waiver of the Part D call center performance requirements for all
Direct Contract and “800 series” EGWPs.
History
(Rev.6, Issued: 11-07-08, Effective/Implementation: 11-07-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
5a67db70880fc43ad49358f704bc4e827eb50105a41c9bcab649eac450a6bac8
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