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Part A and Part B
Medicare Administrative Contractor Statement of Work Attachment J-1 Appendices ONLY Jurisdictions 6, 11, 14 and 15 RFP-CMS-2007-0013, August 30, 2007
Table of Contents 2C.1 Appendices
2C.1.1 Appendix A: Fee-for-Service Shared System Base Functions
12C.1.2 Appendix B: Deliverable Schedule
30C.1.3 Appendix C: Government Furnished Property
45C.1.4 Appendix D: Contractor Furnished Property
46C.1.5 Appendix E: Key Definitions
60C.1.6 Appendix F: Abbreviations
68C.1.7 Appendix G: Additional HIGLAS Requirements
70C.1.8 Appendix H: Joint Operating Agreements
70C.1.8.1 Joint Operating Agreement for the Enterprise Data Center and Medicare Administrative Contractor Testing Requirements
72C.1.9 Appendix I: Re-evaluation Terminology
75C.1.10 Appendix J: Key Personnel
C.9 Appendices
C.9.1 Appendix A: Fee-for-Service Shared System Base Functions
| Function |
| Shared System Provided |
| EDC Provided … |
| Security |
| Application password security via a personnel file containing user authorization flags to control access to specific functions |
| Creation and maintenance of network/environment security rules, via ACF2 |
Data Center security ID and password that controls access into the data center, access into the CICS regions, access to CICS transactions, and read/write access to files.
Data Center security Machine-ID and non-expiring password that controls access into the data center for functions such as IVR and NGD.
Tele-communications
Works with CMS-approved contractors as necessary to establish batch and interactive connectivity between the data centers.
File Transfers
The EDC creates and maintains the jobs necessary to transmit CMS-approved files from the EDC to any other location.
The EDC receives files transmitted from CMS approved contractors.
| Electronic Data Interchange (EDI) |
| MCS and FISS accept CMS’ X12 flat files for HIPAA EDI transactions created from the translation of ANSI ASC X12N version 4010A.1 format, and other EDI transactions as directed by CMS. (There are currently no EDI transaction formats supported other than those implemented per the HIPAA requirements, but CMS could direct at some point that supplemental EDI transaction standards not yet adopted under HIPAA be supported as well.) |
At present, MCS and FISS support a single version of the HIPAA EDI standards. When a subsequent version is adopted as a national standard under HIPAA, it will be necessary for the Contractor to support both the new and the old versions until all users are required to use the new version exclusively.
Perform pre-pass editing and reporting.
MCS furnishes the Professional Provider Telecommunication Network (PPTN) application for provider inquiry of claims status information via a DDE-type screen and a link to the CWF maintained DDE screen established to request and receive beneficiary eligibility information.
| Creation of electronic remittance advices in the HIPAA mandated Format |
| Creation and execution of the jobs to produce the remittance advice flat files for translation into compliant HIPAA standard remittance advice transactions by the MAC or a contractor data center subcontracted to perform this function pending later implementation of a standard front end |
Creation of crossover data for the COBC
Creation and execution of jobs to transmit the crossover flat file claims data to the COBC via the Medicare telecommunications network.
FISS furnishes the Direct Data Entry (DDE) application for provider on-line claim entry, correction of institutional claims, determination of claim status and a link to the CWF maintained DDE screen established to request and receive beneficiary eligibility information.
| Claims Entry |
| Activations and Claims Inquiry System (ACIS) |
Automated Development System (ADS), including a base letter file selected from an existing user
Generation of standard IBM AFP mixed mode or Xerox JDL/JDE print file containing development letters (English or Spanish) that support use of contractor-maintained OMR marks or 3 of 9 barcodes Creation and execution of the jobs to transmit the base print output to the contractor local data center
| A base set of reference files and tables selected from an existing shared system user |
| Creation and execution of the jobs to retrieve the CCI data from the CMS data center and transmit it to the EDC |
On-line work scheduler
Suspense document print file
Weekly EOLQA sampling
| Comprehensive Error Rate Testing (CERT) processing |
| Creation and execution of the jobs to transmit the base output to CMS’ CERT contractor |
| Existing CMS Standard ARU interface in the form of an on-line transaction |
| Ability to connect to the FFS application at the EDC |
Correspondence application that provides ability to track telephone and written correspondence
| Maintenance of screens for manual keying of data contained on paper claims, translation of that data into a flat file for processing, issuance of a claim control number and indicator that identifies the claim as having been submitted on paper (for later claim payment floor and CROWD reporting purposes), front end editing to assure that required fields have been included and there are no obvious errors in the data prior to transfer to the EDC and rejection of claims with appropriate error messages that do not pass that editing |
| Execution of the jobs to complete adjudication of the paper claim data, apply appropriate Medicare program edits, reject claims that do not pass those edits with appropriate reason and remark codes for the 835 flat file, produce data with appropriate reason and remark codes for the 835 flat file when the claim is approved and deposit of the adjudication information on the payment floor when payment is due. |
| Map between paper claims and the system flat file to enable paper claims electronically read and entered using optical character recognition (OCR) technology to be electronically processed, have a claim control number issued, record that the claim was received on paper, perform front end edits and issue appropriate error messages if applicable |
| Execution of the jobs to complete adjudication of the paper claim data, apply appropriate Medicare program edits, reject claims that do not pass those edits with appropriate reason and remark codes for the 835 flat file, produce data with appropriate reason and remark codes for the 835 flat file when the claim is approved and deposit of the adjudication information on the payment floor when payment is due. |
| Correspondence and Customer Service |
| GUI-based MCS Desktop Tool (MCSDT), if desired |
| Ability to connect to the FFS application at the EDC |
Letter-writing application, including a base letter file selected from an existing shared system user
| Generation of standard IBM AFP mixed mode or Xerox JDL/JDE print file for correspondence response letters (English or Spanish) that support use of contractor-maintained OMR marks or 3 of 9 barcodes |
| Creation and execution of the jobs to transmit the base print output to the contractor’s print site (if routing is not done via the JCL) |
| Pricing/ Profiles |
| Maintenance capability for the MPFSDB, customary, prevailing, ambulance fee schedule and zip code file and other relative pricing files |
| Creation and execution of the jobs to retrieve the fee schedule data from the CMS data center and transmit it to the EDC |
Creation and execution of the jobs to extract the contractor-specific fee schedule data
Standard provider profile build logic
Automated pricing of claims
Automated “mass” adjustments capability
Express Adjustments
| Limiting Charge processing |
| Creation and execution of the jobs to transmit the base print output to the contractor’s print site (if routing is not done via the JCL) |
| Medicare Secondary Payer (MSP) |
| Medicare Secondary Payer (MSP) validation through a base set of audits |
MSP automated payment calculation
Identification of MSP recovery claims via IRS/SSA Data Match and retroactive recovery with automated history searching
| Systematic MSP Automated Recovery Tracking (SMART) system |
| Creation and execution of the jobs to retrieve the Data Match files and transmit them to the EDC |
Demand packages in a basic AFP mixed mode or Xerox DJDE print file, along with mailing label print files for certified and non-certified mail
Associated folder label print file Creation and execution of the jobs to transmit the base print output to the contractor’s print site (if routing is not done via the JCL)
Receipt and installation of ECRS software.
| Reporting |
| Provide data used to complete the required CMS reports such as the: |
· Workload and Performance/PULSE file;
· Appeals;
· Medical Review Workload;
· Medical Review Savings;
· PIMR;
· MSP Savings;
· CFO;
· PSOR
· PS&R
Creation and execution of the jobs to transmit the PIMR data to CMS’ PIMR contractor
Creation and execution of the jobs to transmit the CCI report to CMS’ CCI contractor
Creation and execution of the jobs to transmit the data to CMS’ PULSE contractor
| Numerous reports to track and control inventory and production. Refer to report documentation for specifics |
| Creation and execution of the jobs to transmit the base print output to the contractor’s print site (if routing is not done via the JCL) |
| Provide the base data files for use in contractor-specific Ad-Hoc Reporting and Data Extracts |
| Execution of the jobs to create ad-hoc reports or data extracts (with CMS approval) |
| Provider |
| Processes claims using provider enrollment data from the Provider Enrollment Chain Ownership System (PECOS) |
Accepts the PECOS Daily Export Extract file of provider information, used to merge PECOS data with provider data for claims processing Telecommunications mechanism between the EDC and the PECOS
Retrieval of the Daily Export Extract file from the PECOS (one per Contractor number)
Creation of yearly participating (PAR) provider counts
Creation of a weekly mammography report
Validation of certification numbers for mammography facilities Creation and execution of the jobs to retrieve the Mammography Quality Standard Act (MQSA) File from the CMS data center
MCS creates weekly tapes for the RRB containing provider extract data
| Interface to Finalist zip code cleansing software to cleanse provider addresses |
| Receipt and installation of Finalist software and database updates |
| Provider file accessor |
| Execution of the jobs to create ad-hoc reports or data extracts (with CMS approval) |
| Provide access to the data required to produce the MEDPARD |
| Execution of the jobs to extract provider data (with CMS approval) |
Creation and execution of the jobs to transmit the extracted data to contractor data center
| Desktop Label and Reporting database application (PIN Support (PSUP) Query appl.) |
| Creation and execution of the jobs to transmit the extracted data to contractor data center |
| CWF Interaction |
| Creation of CWF transmits files for claims, MSP, and eligibility data |
| Creation and execution of the jobs to transmit the data to the CWF host |
| Accepts CWF response files for claims, MSP and eligibility data |
| Receipt of CWF response files from CWF Host |
| Interaction with HIMR Eligibility and Claim Data on a subset of MCS screens. |
| Receipt and installation of HIMR software |
Bridge between the FISS DDE System and the CWF ELGA screen for eligibility inquiries by providers
Receipt and installation of CWF ELGA software.
| Bridge between the Professional Provider Telecommunication Network (PPTN) and the CWF ELGB screen for eligibility inquiries by providers |
| Receipt and installation of CWF ELGB software |
| Accounting/ Financial |
| Standard interface for bank issues/clears |
| Support of telecommunications with bank or contractor data center |
Creation and execution of bank-specific interfaces for Issues file (optional, with CMS approval)
Creation and execution of the jobs to transmit the issues file to the bank or contractor data center
Receipt of the Clears file from the bank (optional)
Creation and execution of bank-specific interfaces for Clears file (optional, with CMS approval)
Stale date processing
Mailroom-ready output document files, suitable for printing on IBM equipment, that have:
· Basic AFP mixed mode print file;
· Parameters to control additional mail finishing marks;
· OMR coding or 3 of 9 barcodes for outgoing financial documents;
· Separate checks, MSNs, and remittance with AFP mixed mode formatted print streams;
· English language printed output for all documents, and Spanish language for the beneficiary Medicare Summary Notice (MSN);
· Base Presort processing Creation and execution of the jobs to transmit the base print output to the contractor’s print site (if routing is not done via the JCL)
— OR —
Mailroom-ready output document files, suitable for printing on Xerox equipment that have:
· Xerox print file;
· Parameters to control additional mail finishing marks;
· OMR coding or 3 of 9 barcodes for outgoing financial documents;
· MSNs and remittance with Xerox JDL/JDE formatted print streams;
· English language printed output for all documents, and Spanish language for the beneficiary MSN;
· Base Presort processing Creation and execution of the jobs to transmit the base print output to the contractor’s print site (if routing is not done via the JCL)
| Interface to Finalist zip code cleansing software |
| Receipt and installation of Finalist software and database updates |
Cash receipts processing
Accounts receivable processing
Accounts payable processing
| Creation of ACH EFT records, pre-notification records, and X12 835 records |
| Support of telecommunications with bank |
Creation and execution of the jobs to transmit the ACH records to the bank or the contractor data center.
| Accumulation of monthly, quarterly, and yearly financial data to create a 1099 database reflecting annual provider and beneficiary earnings |
| Creation and execution of the jobs to transmit the 1099 records to the contractor data center |
HPSA processing which includes:
· Incentive checks in the same format as other special checks;
· Incentive payment reports;
· HPSA guideline monitoring reports;
· Suppression of HPSA checks for violators
· Notification of providers of those claims for which the HPAA bonus is being paid
| National Change of Address (NCOA) |
| Creation of a standard format file for NCOA processing |
Accept standard format NCOA file used to update beneficiary address data Support of telecommunications with vendor
Creation and execution of vendor-specific interfaces for NCOA file (with CMS approval)
Creation and execution of the jobs to transmit the NCOA records to the NCOA vendor or the contractor data center.
| Interface to Finalist zip code cleansing software to cleanse NCOA address data |
| Receipt and installation of Finalist software and database updates for all contractors |
| File layouts to support the extract of data. |
| Creation and execution of the jobs to extract the data and transmit the data to the data storage location (with CMS approval) |
| Payment Safeguards |
| File layouts to support the extract of data. |
| Creation and execution of the jobs to extract the data and transmit the data to the data storage location (with CMS approval) |
Automated history search capability to interface with ARGUS
Sampling capability in support of focused medical review (online history plus 4 years of purged history)
| Standard interface to Program Integrity Sampling Module for Part B and DME contractors (PIMB) |
| Receipt and installation of PIMB software |
| File Purges |
| Standard purge logic |
Capability to retrieve information by beneficiary from purged history
| Other Add-on Software |
| Image request transaction files (RQ screen) |
| National Provider Identifier Crosswalk |
| Access to NPI Crosswalk during claims processing as well as a claim by claim basis by contractor staff. |
C.9.2 Appendix B: Deliverable Schedule
| Related SOW Requirement Number and Name |
| Deliverable Name |
| Deliverable Description |
| Deliver to |
| Deliverable Due Date |
| Frequency |
| CMS Business Owner Functional Area |
| C.5.1.1 Jurisdiction Implementation Project Plan |
| Jurisdiction Implementation Project Plan |
| A detailed description of all activities required to transfer all Medicare operations from each carrier and intermediary in the contractor’s jurisdiction. |
| Project Officer and/or Designees |
| Baseline due within 30 calendar days after contract award |
| Once |
| Center for Medicare Management (CMM) / Medicare Contractor Management Group (MCMG) / Division of Medicare Administrative Contractor (MAC) Program Management (DMPM) |
| C.5.1.2 Segment Implementation Project Plans |
| Segment Implementation |
Project Plan
| An expanded part of the Jurisdiction Implementation Project Plan that specifies in more detail the transfer of that segment’s workload. |
| Project Officer and/or Designees |
| Draft due at segment kickoff meeting. Baseline due within 30 calendar days of segment kickoff meeting |
| Twice |
| CMM / MCMG / DMPM |
| C.5.1.3 Risk Management Plan |
| Risk Management Plan |
| Identifies the jurisdiction wide as well as segment specific risks, mitigation strategies, and maintenance process for the risks associated with the contractor’s segment workload transition |
| Project Officer and/or Designees |
| Initial due within 30 calendar days of each Segment Kickoff meeting |
| Once |
| CMM / MCMG / DMPM |
| C.5.1.4 Segment Cutover Plan |
| Segment Cutover Plan |
| An expanded part of the Segment Implementation Project Plan that contain the day by day activities and procedures, some of which may be detailed to the hour, that the contractor will follow during the cutover period to ensure a successful cutover for a particular segment. |
| Project Officer and/or Designees |
| Initial within 45 calendar days prior to the segment cutover date contained in the Segment Implementation Project Plan |
| Once |
| CMM / MCMG / DMPM |
| C.5.1.5 Segment Test Plans |
| Segment Test Plan |
| A plan to identify the approach to testing, types of tests, schedule, and progress for each segment implementation. |
| Project Officer and/or Designees |
| Initial within 30 calendar days after segment kickoff meeting |
| Once |
| CMM / MCMG / DMPM |
| C.5.1.6 Implementation Requirements |
| Lessons-Learned Document Regarding Implementation Activities |
| Identifies the lessons learned during the implementation of each segment. |
| Project Officer and/or Designees |
| Within 40 calendar days after segment cutover |
| Once |
| CMM / MCMG / DMPM |
| C.5.1.7 Accounts Receivable Reconciliation |
| Accounts Receivable Transmittal Document |
| Describes the total amounts and counts of the accounts receivables of the outgoing contractor. |
| Project Officer and/or Designees |
| Due within 10 calendar days after the date of transfer |
| Once |
| CMM / MCMG / DMPM and OFM/DFRP |
| C.5.1.9 Implementation Stakeholder Communication |
| Communications Plan |
| Identifies the processes and procedures the contractor will follow to ensure that all transition stakeholders are informed of the transition and its progress. |
| Project Officer and/or Designees |
| Initial within 30 calendar days of Segment Kickoff Meeting |
| Once |
| CMM / MCMG / DMPM |
| C.5.2.1 Workload Closeout Project Plan (Option that may be exercised at the End of the Contract) |
| Workload Closeout Project Plan |
| Describes the outgoing contractor’s plan for the transfer of Medicare functions and the closeout of operations at contract end. |
| Project Officer and/or Designees |
| Initial within 30 calendar days of replacement contractor kickoff meeting |
| Once |
| CMM / MCMG / DMPM |
| C.5.2.1 Closeout Project Plan (Option that may be exercised at the End of the Contract) |
| Jurisdiction Workload Closeout Report |
| Identifies workload indicators for a jurisdiction to allow CMS to determine if the outgoing Contractor is processing claims in accordance with the SOW. |
| Project Officer and/or Designees |
| Within 3 business days of biweekly period end |
| Biweekly |
| CMM / MCMG / DMPM |
| C.5.2.3 Workload Closeout Risk Management Plan |
| Workload Closeout Risk Management Plan |
| Includes a periodic assessment of new risks and mitigation and contingency planning where appropriate. |
| Project Officer and/or Designees |
| Initial Due within 30 calendar days of replacement contractor kickoff meeting |
| Once |
| CMM / MCMG / DMPM |
| C.5.2.4 Accounts Receivable Transmittal Document (Option that may be exercised at the End of the Contract) |
| Accounts Receivable Transmittal Document |
| Describes the total amounts and counts of the accounts receivables of the outgoing contractor. |
| Project Officer and/or Designees |
| Due within 10 calendar days after the date of transfer |
| Once |
| CMM / MCMG / DMPM and OFM/DFRP |
| C.5.2.5 Cost Accounting/Audit (Option that may be exercised at the End of the Contract) |
| Financial Audit Supporting Documentation |
| Describes the details to support the post-cutover financial activities of the outgoing contractor. |
| Project Officer and/or Designees |
| Within 30 calendar days after closeout end |
| Once |
| CMM / MCMG / DMPM |
| C.5.2.5 Cost Accounting/Audit (Option that may be exercised at the End of the Contract) |
| Administrative Supporting Documentation |
| Describes the details to support the post-cutover administrative activities of the outgoing contractor. |
| Project Officer and/or Designees |
| Within 30 calendar days after closeout end |
| Once |
| CMM / MCMG / DMPM |
| C.5.4.3 Security |
| Information Technology Systems Contingency Plan Report |
| Information Technology (IT) Systems Contingency Plan (See BPSSM Table 3.1 Planning Table, for 3.4) |
| Project Officer and/or Designees |
| Initial within 90 days prior to the first segment cutover date and annually thereafter |
| Annually |
| OIS |
| C.5.4.3 Security |
| IT Security Tests And Reports |
| Contractor conducted or any other independent IT evaluation |
| Project Officer and/or Designees |
| 10 business days after conducted |
| As required |
| OIS |
| C.5.4.3 Security |
| Risk Assessment Report |
| Risk Assessment (See BPSSM Table 3.1 Planning Table, for 3.2) |
| Project Officer and/or Designees |
| Initial within 90 days prior to making AB payments under the contract and annually thereafter |
| Annually |
| OIS |
| C.5.4.3 Security |
| Statement of Security Compliance |
| Annual certification (See BPSSM Table 3.1 Planning Table, for 3.3) |
| Project Officer and/or Designees |
| In accordance with BPSSM |
| C.5.4.3 Security |
| Systems Security Plan |
| Systems Security Plan (SSP) (See BPSSM Table 3.1 Planning Table, for 3.1) |
| Project Officer and/or Designees |
| Initial within 90 days prior to making AB payments under the contract and annually thereafter |
| Annually |
| OIS |
| C.5.4.3 Security |
| Systems Security Profile Documentation |
| Systems Security Profile (See BPSSM Table 3.1 Planning Table, for 3.7) |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| OIS |
| C.5.4.3.2 Administer Security Program |
| Annual Compliance Audit Report |
| Annual compliance audits (See Business Partner System Security Manual— Business Partners Systems Security Manual (BPSSM) Table 3.1 Planning Table, for 3.5) |
| Project Officer and/or Designees |
| In accordance with BPSSM |
| Annually |
| OIS |
| C.5.4.3.2 Administer Security Program |
| Self Assessment |
| Results of self-assessments, using the Contractor Assessment Security Tool (CAST) module of the CMS Integrated Security Suite (CISS), provided by CMS (See BPSSM Table 3.1 Planning Table, for Appendix A) |
| Project Officer and/or Designees |
| Initial within 90 calendar days prior to making AB payments under the contract and in accordance with the BPSSM thereafter |
| Annually |
| OIS |
| C.5.4.3.2 Administer Security Program |
| Corrective Action Management Process Report |
| Report progress in correcting deficiencies or findings identified by audits, reviews, etc. in accordance with guidance provided by the BPSSM and other CMS guidance. |
| Project Officer and/or Designees |
| In accordance with BPSSM or as requested by CMS (Corrective Action Plans for findings identified in Section 912 Evaluations must be remedied prior to making payments). |
| Monthly |
| OIS |
| C.5.4.3.4 Correct Deficiencies |
| Incident Reporting and Response Report |
| Incident Reporting and Response (See BPSSM Table 3.1 Planning Table, for 3.6) |
| Project Officer and/or Designees |
| Within 15 calendar days of month end or as required by CMS. Incidents involving individually identifiable information must be reported within one hour |
| Monthly and As required |
| OIS |
| C.5.4.4.1 Quality Control Program |
| Quality Control Plan |
| Specifies the procedures and resources applied to ensure services meet contract performance requirements |
| Project Officer and/or Designees |
| No later than 45 calendar days after contract award; once on contract cutover date; quarterly thereafter |
| Quarterly |
| CMM/MCMG |
| C.5.4.5 Public Relations |
| Public Relations Plan |
| Describes the contractor’s plans for managing the programs public relations. |
| Project Officer and/or Designees |
| Initial within 30 calendar days of contract award, thereafter within 7 calendar days of annual period end |
| One month after contract award then Annually thereafter |
| CMM/MCMG |
| C.5.4.8.3 Successful Implementation of Change Requests |
| Change Request Implementation Problem Log |
| Describes any problems and the resolution status associated with the implementation of change requests. |
| Project Officer and/or Designees |
| Within 15 calendar days of month end |
| Monthly |
| CMM/MCMG/ |
DCM; CMM/Provider Billing Group (PBG)/Division of Supplier Processing (DSCP)
| C.5.4.8.3 Successful Implementation of Change Requests |
| Change Request Implementation Report |
| Describes the Change Requests (CRs) that the contractor has implemented in the quarterly period. |
| Project Officer and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| CMM/MCMG/ |
Division of Change and Operations Management (DCOM)
| C.5.4.9 Business Continuity Planning and Disaster Recovery |
| Comprehensive Continuity of Operations (COOP) Plan |
| Describes the Contractor’s policies and procedures to ensure that essential business functions continue during a disaster. The COOP plan elements include protection of physical infrastructure, IT disaster recovery, business continuity (with or without system availability), and other topics |
| Project Officer and/or Designees |
| Initial 60 calendar days prior to cutover; thereafter annually as requested by CMS. |
| Once, then Annually |
| CMM/OIS |
| C.5.4.10.3 Self Assessment Process for Internal Controls |
| Certification Package for Internal Controls (CPIC) Report |
| Attestation and documentation of the adequacy of the internal controls. |
| Project Officer and/or Designees. CPIC should also be delivered to CMS internalcontrols@\cms.hhs.gov. |
| Initial is due within 15 business days after June 30; Update is due 3 business days after September 30. |
| Annually |
| OFM/ Accounting Management Group (AMG)/ Division of Debt Referral and Oversight (DDRO) |
| C.5.4.10.3 Correcting Internal Control Deficiencies – CAP process |
| Corrective Action Plan (CAP) |
| Describes a plan of action to correct weaknesses, findings, gaps, or other deficiencies. |
| Project Officer and/or Designees. CAP reports should also be delivered to CMS CAPS@cms.hhs.gov. |
| Initial CAP reports are due within 45 calendar days of receiving a final audit report or after discovery of a material weakness; thereafter 30 calendar days form quarter end |
| Within 45 calendar days after discovery of material weakness, and quarterly |
| OIS and OFM/AMG/ |
DDRO
| C.5.4.10.4 Statement on Auditing Standards 70 Audit |
| Final Statement on Auditing Standards (SAS) 70 Report |
| Describes the Final SAS 70 Report includes a matrix at Section I reporting all SAS 70 findings. Working papers and supporting documentation must be made available upon request to any party designated by CMS. |
| Project Officer and/or Designees |
| Draft Report due by June 15 of each fiscal year. |
Final Report due by July 1 of each fiscal year.
DDRO
| C.5.7.1.6 Bulletin/Newsletter Publication |
| Alternative Bulletin Plan |
| Plan for electronic distribution of bulletins/newsletters |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| As requested |
| As required |
| CMM/PCG/ |
DCPC
| C.5.7.1.6 Bulletin/Newsletter Publication |
| Alternative Bulletin Evaluation |
| Evaluation of alternative bulletin implementation |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| 6 months after implementation of alternative bulletin approach |
| As required |
| CMM/PCG/ |
DCPC
| C.5.7.1.7 Provider Service Plan |
| Provider Service Plan (PSP) |
| Describes the outreach and education activities the contractor will accomplish throughout the year |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| End of first month of contract year |
| Annual |
| CMM/PCG/ |
DCPC
| C.5.7.1.7 Provider Service Plan |
| Home Health and Hospice Provider Service Plan (PSP) |
| Describes the outreach and education activities the contractor will accomplish throughout the year specific to its home health and hospice work |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| End of first month of contract year |
| Annual |
| CMM/PCG/ |
DCPC
| C.5.7.1.8 Education Activity Report |
| Education Activity Report (EAR) |
| Summarizes and recounts the completed Provider Outreach and Education activities in the previous 5.5-6 month period. |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| At end of 7th month of contract year and end of the last month of the contract year. |
| Semiannual |
| CMM/PCG/ |
DCPC
| C.5.7.1.8 Education Activity Report |
| Home Health and Hospice Education Activity Report (EAR) |
| Summarizes and recounts the completed Provider Outreach and Education activities in the previous 5.5-6 month period specific to its home health and hospice work. |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| At end of 7th month of contract year and end of the last month of the contract year. |
| Semiannual |
| CMM/PCG/ |
DCPC
| C.5.7.2 Provider Contact Center |
| Primary Provider Inquiry Contact |
| Contact information for primary Provider Contact Center (PCC) contact at contractor. |
| Project Officer and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of first month of contract year |
| Annual, as needed as changes made |
| CMM/PCG/ |
DCPC
| C.5.7.2 Provider Contact Center |
| Planned Contact Center Closure |
| Schedule of planned closures for contact center, including Federal holiday closures |
| Project Officer and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of first month of contract year |
| Annual |
| CMM/PCG/ |
DCPC
| C.5.7.2 Provider Contact Center |
| Ad Hoc Closure Requests |
| Requests to close contact centers at times different from planned closures |
| Project Officer and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| As needed, at least 3 weeks before requested closure date |
| As requested |
| CMM/PCG/ |
DCPC
| C.5.7.2 Provider Contact Center |
| Customer Service Operations Surveys |
| Surveys of contractor’s customer service operations, such as PCC technology, staffing, training needs. |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Upon request |
| As requested |
| CMM/PCG/ |
DCPC
| C.5.7.3.4 Provider Customer Service Program Staff Training |
| Contact Center Training Schedules |
| A training schedule, including dates, times, topics, subtopics, and contact information about PCC closure |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| 15th of month prior to training closure |
| Monthly |
| CMM/PCG/ |
DCPC
| C.5.7.3.4 Provider Customer Service Program Staff Training |
| Requests for PCC Closure Greater than 4 Hours |
| A request to close PCC for more than 4 hours in a day |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| 1 month prior to requested training date |
| As requested |
| CMM/PCG/ |
DCPC
| C.5.7.3.4 Provider Customer Service Program Staff Training |
| Provider Complaints about PCC Closure |
| Report about provider complaints and their resolution related to PCC closures |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| Upon request |
| As requested |
| CMM/PCG/ |
DCPC
| C.5.7.2.1 Telephone Inquiries |
| Remote Monitoring Instructions |
| Instructions for CMS to remotely monitor live provider inquiry calls |
| Project Officer and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| 3 business days before instructions are active |
| Annual, and as instructions change |
| CMM/PCG/ |
DCPC
| C.5.7.2.1 Telephone Inquiries |
| Disaster Recovery Plans |
| Plan describing how the Medicare provider telecommunications operations will be maintained or continued in event of natural or manmade disaster |
| Project Officer and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of third month of contract year |
| Annual |
| CMM/PCG/ |
DCPC
| C.5.7.2.1 Telephone Inquiries |
| Interruption of Call Center Service Report |
| Report about interruption of telecommunications service, both Verizon related and in-house |
| Project Officer and/or Designees and mailbox ServiceReports@cms.hhs.gov |
| End of month |
| Monthly |
| CMM/PCG/ |
DCPC
| C.5.7.2.4 Inquiry Tracking System |
| Inquiry Tracking Report |
| Report of all provider inquiries using standard inquiry categories. |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| End of month following each quarter of contract year |
| Quarterly |
| CMM/PCG/ |
DCPC
| C.5.7.2.4 Inquiry Tracking System |
| Home Health and Hospice Inquiry Tracking Report |
| Report of all home health and hospice provider inquiries using standard inquiry categories. |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| End of month following each quarter of contract year |
| Quarterly |
| CMM/PCG/ |
DCPC
| C.5.7.3.2 Web Technology |
| Website attestation statement |
| Statement by contractor attesting that CMS contractor website guidelines have been followed |
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| End of sixth month of the contract year |
| Annually |
| CMM/PCG/ |
DCPC
| C.5.7.3.2 Web Technology |
| Website attestation statement about Current Procedural Terminology (CPT) usage |
| Statement by contractor attesting whether website adheres to requirements in IOM Pub 100-4, .5.3.1 |
, §20.7
| Project Officer and/or Designees and mailbox ProviderServices@cms.hhs.gov |
| End of sixth month of contractor year |
| Annual |
| CMM/PCG/ |
DCPC
| C.5.8.2.5 Payment of Claims Outside Common Working File |
| Workload Report for Payment of Claims Outside Common Working File |
| Workload Report for Payment of Claims Outside Common Working File |
| Project Officer and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| CMM/MCMG |
| C.5.8.4.4 The Do Not Forward Initiative |
| Do-Not-Forward (DNF) Initiative Report |
| Describes the Medicare checks and payments for professional claims returned or held to the contractor thru the DNF initiative. |
| Project Officer and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| CMM/PBG |
| C.5.8.5 Opt-Out Payment Provisions |
| Private Contracting Report |
| Describes the physicians and practitioners who opt out of Medicare. |
| Project Officer and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| CMM/PBG |
| C.5.8.6 Physician Incentive Payments for Services in Health Professional Shortage Area and Physician Scarcity Area |
| Health Professional Shortage Area (HPSA) Report |
| Describes the physicians and services furnished in geographic HPSAs and Physician Scarcity Areas (PSAs). |
| Project Officer and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| CMM/PBG |
| C.5.8.6 Physician Incentive Payments for Services in Health Professional Shortage Area and Physician Scarcity Area |
| Physician Incentive Payment Report |
| Describes the physician incentive or bonus payments made for primary care and mental health care services furnished in geographic HPSAs and PSAs. |
| Project Officer and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| CMM/PBG |
| C.5.10.3 Monthly Statistical Report (Validation) |
| Validation of data on CMS-2592 Report |
| Provides validation of data reported monthly on the CMS-2592 Report |
| Project Officer and CMS Business Owner |
| Twice a year, due May 15th for the months of October through March; due November 15th for the months of April through September. |
| Semi-annually |
| CBC/MEAG/DAO |
| C.5.10.4 Quality Improvement/Data Analysis |
| Appeals Quality Improvement/Data Analysis (QI/DA) Report |
| Submits Summary Report of QI/DA activities and findings in accordance with IOM 100-4, chapter 29, Sections 70 and 350. |
| Project Officer and CMS Business Owner |
| Twice a year, due May 15th for the months of October through March; due November 15th for the months of April through September. |
| Semi-annually |
| CBC/MEAG/DAO |
| C.5.11.2 Banking Relations |
| Copy of Tripartite Agreement |
| Describes the agreement between CMS, the contractor and its bank. |
| Project Officer and/or Designees |
| Upon initiation |
| Once |
| OFM / Financial Services Group (FSG) |
| C.5.11.2.4 Letter-of-Credit Limitation |
| Letter of Credit Limitation Change Request |
| Written requests for changes to the monthly letter-of-credit limitation. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| OFM/FSG |
| C.5.11.3.2.9 Audit Plan |
| Audit Plan |
| Identifies the audit plan, including the providers and issues projected for audit. |
| Project Officer and/or Designees |
| Initial within 30 calendar days of cutover; thereafter within 30 calendar days of annual period end |
| Annually |
| OFM/FSG |
C.5.11.3.3 Institutional Provider Reimbursement
C.5.11.3.3.12 Institutional Provider Reimbursement
| Periodic Interim Payment (PIP) Termination Recommendation |
| Describes recommendations on providers that should be terminated from PIP. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| MCMG |
| C.5.11.3.3.9 Provider Based Determinations |
| Provider Based Determination Correspondence and Decision Recommendations |
| Describes the provider based determination correspondence and decision recommendations. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CMM |
| C.5.11.3.3.5 Target Limits: Tax Equity and Fiscal Responsibility Act |
| Target limits under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) Report |
| Describes the TEFRA Target Limits for each Provider. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CMM/Hospital and Ambulatory Policy Group (HAPG) |
| C.5.11.3.3.6 Exception Requests: End-Stage Renal Disease |
| Processed End-Stage Renal Disease Exception Requests Report |
| Describes the exception requests for ESRD facilities processed. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CMM |
| C.5.11.3.3.7 Exception Requests: Tax Equity and Fiscal Responsibility Act |
| Processed Requests for Exception to the Tax Equity and Fiscal Responsibility Act of 1982 Report |
| Describes the exception requests for TEFRA limits processed. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CMM |
| C.5.11.3.3.10 Special Payment Status |
| Recommendation for Special Payment Status |
| Describes the recommendations for special payment status. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CMM |
| C.5.11.3.2.7 Wage Index |
| Completed Wage Index Review |
| Contractor’s review of the provider’s cost report desk review for Wage Index Information |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CMM/HAPG |
| C.5.11.4.2 Applications for Extended Plan |
| Extended Repayment Plan (ERP) Extension Requests |
| Usually in Excel format, this report identifies providers who have requested an ERP and identifies those requests that have been approved and denied. |
| Project Officer and/or Designees |
| Within 15 calendar days of quarter end |
| Quarterly |
| OFM / FSG / Division of Medicare Overpayments (DMO) |
| C.5.11.7.1 Unsolicited/Voluntary Refunds |
| Unsolicited/Voluntary Refund Check Summary Report |
| Describes a summary of the unsolicited/voluntary refund checks. |
| Project Officer and/or Designees |
| Within 15 calendar days of quarterly end |
| Quarterly |
| OFM / Program Integrity Group (PIG) |
| C.5.11.8.1 Administrative Freeze Payments |
| Provider Overpayment Referral Checklist |
| Describes summary of overpayment information for a Provider in bankruptcy. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| OFM / AMG / DFO |
| C.5.11.8.2 Closed Bankruptcy Case |
| Quarterly Bankruptcy Tracking Report |
| Describes the status of the discharge of bankruptcy proceedings. Builds on the information contained in the summary of detailed underpayment and overpayment information for a Provider in bankruptcy. |
| Project Officer and/or Designees |
| Quarterly |
| As required |
| OFM / AMG / DFO |
| C.5.11.9 Financial Reporting and Accounting |
| Statement of Financial Position and Status Accounts Receivable |
| Forms CMS 750/751 Describes the accounts receivable activity for Fiscal year-to-date |
| Project Officer and/or Designees |
| Within 21 days of the quarter end |
| Quarterly |
| OFM / AMG / DFRP |
| C.5.11.9.1 Accounts Receivable Trend Analyses |
| Accounts Receivable Trend Analysis Reports |
| Describes the results of accounts receivable trend analyses. |
| Project Officer and/or Designees |
| Within 7 and/or 15 calendar days of quarterly submission of CFO reports |
| Quarterly |
| OFM / AMG / DFRP |
| C.5.11.10 Medicare Credit Balance Report Activities |
| Credit Balance Summary Report |
| Describes a summary of the credit balances. |
| Project Officer and/or Designees, and mailbox CMS_SCBR@cms.hhs.gov |
| Within 90 calendar days after the close of the quarterly period |
| Quarterly |
| OFM / AMG / DFO |
| C.5.12.1 Development of Medical Review Strategy |
| Medical Review Strategy Report |
| Describes the operational plan for how the contractor will evaluate data and address program vulnerabilities throughout the year. |
| Project Officer and/or Designees |
| Initial within 60 calendar days after contract award, thereafter 30 calendar days prior to option award |
| Annually |
| OFM/ Program Integrity Group (PIG)/ Division of Medical Review and Education (DMRE) |
| C.5.12.1 Development of Medical Review Strategy |
| Analysis Report |
| A quarterly update to the MR Strategy Report that describes progress towards goals as defined in the strategy and any changes that need to be made to the strategy. |
| Project Officer and/or Designees |
| Within 45 calendar days of quarter end |
| Quarterly |
| OFM/PIG/DMRE |
| C.5.13.2 Support of Comprehensive Error Rate Testing |
| Error Rate Reduction Plan Report |
| Describes the error rate reduction plan and is updated once per year. |
The error rate reduction plan (ERRP) database is the primary collection tool for the error rate reduction plans.
| Project Officer and/or Designees |
| Initial within 60 calendar days of contract award; a new plan is required each year following the release of the November error rate report; an update to the ERRP Report is required six (6) months following the November Report |
| Semi-annually (twice per year) |
| OFM / PIG / Division of Analysis Evaluation (DAE) |
| C.5.14.5 Medicare Secondary Payer Hospital Audits |
| Hospital Audit Report |
| Describes the results of hospital audits and reviews for Medicare Secondary Payer hospitals. |
| Project Officer and/or Designees |
| Within 30 calendar days from final audit completion |
| Annually |
| OFM/FSG/ Division of Medicare Secondary Payer (MSP) Operations |
DMSPO
| C.5.14.6.1 Duplicate Primary Payments |
| Unsolicited/Voluntary MSP Posted Checks Status Report (identifying associated vs. not associated with a known debt) |
| Provides a listing of all Posted Provider, Physician, or Other Supplier MSP Unsolicited/Voluntary Refund Checks (identifying each entry as (1) associated to a known debt vs. (2) NOT associated to a known debt and ECRS entry required) received by the MAC Contractor. |
| Project Officer and/or Designees |
| Last business day of the month |
| Monthly |
| OFM/DMSPPO |
| C.5.14.6.2 Inquiries Specific to Debt Collection Efforts for Providers, Physicians, and other Suppliers |
| MSP Pending Correspondence Report |
| Provides a listing of all pending MSP correspondence. |
| Project Officer and/or Designees |
| Last business day of the month |
| Monthly |
| OFM/DMSPPO |
C.5.14.6.5 Misrouted Medicare Secondary Payer Recovery Checks
| Medicare Secondary Payer (MSP) Misrouted Recovery Checks (and Associated Correspondence) |
| Provides a listing of all misrouted checks and correspondence that was transferred to the Medicare Secondary Payer Recovery Contractor |
| Project Officer and/or Designees |
| Last business day of the month |
| Monthly |
| OFM/DMSPPO |
| C.5.14.6.6 Misrouted Medicare Secondary Payer Post Payment Recovery |
| Medicare Secondary Payer (MSP) Misrouted Recovery Correspondence |
| Provides a listing of all misrouted correspondence that was transferred to the Medicare Secondary Payer Recovery Contractor |
| Project Officer and/or Designees |
| Last business day of the month |
| Monthly |
| OFM/DMSPPO |
| C.5.15.2 Review of Comprehensive Outpatient Rehabilitation Facility Billing Records |
| Aberrant Billing Practices Notification |
| Immediate written notification whenever aberrant billing practices are discovered |
| Project Officer and/or Designees |
| Consistent with Frequency |
| As required |
| CMSO/SCG/ |
DCCP
| C.5.15.3 Review of Inpatient Rehabilitation Facilities and Critical Access Hospitals’ Rehabilitation Distinct Part Units (DPU) |
| Written Report of the Applicable Calculated Compliance Percentage |
| Written report of the applicable calculated compliance percentage attained by the IRF or a provider attempting to be classified as an IRF. |
| Project Officer, CMS Business Owner, and the RO responsible for the geographic area where the IRF is located, and, if appropriate, to the appropriate ROs involved with the administration of the MAC contract. |
| Six weeks prior to the beginning of an IRF’s next cost reporting period |
| As required |
| CMM/ Chronic Care Policy Group (CCPG)/ Division of Institutional Post Acute Care (DIPC) |
| C.5.18.1 Education Materials |
| Rural Health Clinic (RHC) Education Materials |
| The Contractor is encouraged to use CMS-created national education materials when training RHCs. |
| Project Officer and/or Designees |
| Six weeks prior to the intended use of the education materials |
| As required |
| CMM / MCMG/ DMPM |
| C.5.19.1 Education Materials |
| Federally Qualified Health Center Education Materials |
| The Contractor is encouraged to use CMS-created national education materials when training FQHCs. |
| Project Officer and/or Designees |
| Six weeks prior to the intended use of the education materials |
| As required |
| CMM / MCMG/ DMPM |
| C.5.23.1 Post-Award Meeting |
| Post-Award Meeting Minutes |
| Describes the results of the Post-Award meeting conducted. |
| Project Officer and/or Designees |
| Within 3 business days of the Post-Award meeting |
| Once |
| CMM/MCMG |
| C.5.23.2 Project Management Plan |
| Project Management Plan |
| Describes the plan for overall management of the program. |
| Project Officer and/or Designees |
| Initial within 30 business days after contract award, updates within 15 calendar days after quarter end |
| Quarterly |
| CMM/MCMG |
| C.5.23.3 Cost Management |
| Cost Management Reports |
| Describes the Cost Management Reports associated with the overall program. |
| Project Officer and/or Designees |
| Initial within 30 business days after contract award, updates within 15 calendar days after month end |
| Monthly |
| CMM/MCMG |
| C.5.23.5 Monthly Status Report and Meeting |
| Monthly Status Report and Meeting |
| Describes the monthly status of the program thru a report and briefing. |
| Project Officer and/or Designees |
| Within 15 calendar days after month end |
| Monthly |
| CMM/MCMG |
| C.6.1 Joint Operating Agreements |
| Initial Joint Operating Agreement (JOA) |
| The initial JOA defines roles and responsibilities of a mutually agreed upon methods to work with and support CMS’ mission—with each of the following parties: Program Safeguard Contractors (PSCs) with Benefit Integrity (BI) task orders; other specialty PSCs, if applicable; Qualified Independent Contractors (QICs); Administrative Qualified Independent Contractors (AdQICs); Quality Improvement Organizations (QIOs); Recovery Audit Contractors (RACs); Beneficiary Contact Center (BCC); and Enterprise Data Center (EDC). |
| Project Officer and/or Designees |
| 30 calendar days prior to cutover |
| Once |
| Office of Acquisitions and Grants Management (OAGM) |
| C.6.1 Joint Operating Agreements |
| Updated Joint Operating Agreement |
| The updated JOA defines any updates to the roles and responsibilities of a mutually agreed upon methods to work with and support CMS’ mission—with each of the following parties: PSCs with BI task orders; other specialty PSCs, if applicable; QICs; AdQICs; QIOs; RACs; and BCC. |
| Project Officer and/or Designees |
| Consistent with frequency updates: By January 15th, April 15th, July 15th, and October 15th. |
| First Year Quarterly; Subsequent Years Semiannually |
| OAGM |
| C.6.1.1.1 Referrals to Quality Improvement Organization |
| Quality Improvement Organization Referrals |
| Describes the referrals to the QIO for medical necessity determinations. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| Office of Clinical Standards and Quality (OCSQ) |
| C.6.1.1.2.1 Payment Adjustments |
| Quality Improvement Organization on Processed/Unprocessed Adjustments Report |
| Describes the payment adjustments submitted by the QIOs based on medical necessity determinations and DRG validations, including corrections to the disposition code. |
| Project Officer and/or Designees |
| Within 15 calendar days of month end |
| Monthly |
| OCSQ |
| C.6.1.1.2.2 Billing Errors |
| Billing Error Report |
| Describes the billing error notifications from QIO and actions taken/not taken to resolve the errors. |
| Project Officer and/or Designees |
| Within 15 calendar days of month end |
| Monthly |
| OCSQ |
| C.6.1.2.1 Supply of Appeals Case Files |
| Supply of Appeals Case Files Report |
| An electronic report that describes the number of requests from the QIC for redetermination case files (in cases and claims); number of case files forwarded to the QIC in 1–5 days, in 6–10 days, in more than 10 days (in cases and claims); average time to forward redetermination case files; number of case file requests that are pending (request received but files not yet sent to QIC) (in cases and claims); and cost of preparing and forwarding redetermination case files. |
| Project Officer and/or Designees |
| Within 15 calendar days of month end |
| Monthly |
| CBC/MEAG/DAO |
| C.6.1.2.3 Preparation of Case Files |
| Case Files |
| Describes the case files in accordance with the JOA. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CBC/MEAG/DAO |
| C.6.2.1 State Agencies Responsible for Licensing Institutional Providers (e.g., Survey and Certification, Licensing Authorities) |
| Health Insurance Benefits Agreement, Provider-Based Determination, or Other Institutional Provider Information |
| The Health Insurance Benefits Agreement, Provider-Based Determination, or Other Institutional Provider Information is provided in the format requested to state agencies with a copy to CMS. |
| Project Officer and/or Designees |
| Consistent with frequency |
| As required |
| CMSO/SCG/ |
DACS
| C.7.11 Medicare Part B Drug Code Crosswalk File – Jurisdiction 11 |
| Crosswalk File |
| Describes drug and biological codes classified through HCPCS |
| Project Officer and/or Designees |
| February 15, May 15, August 15, and November 15 |
| Quarterly |
| CMM/HAPG/DAS |
| C.7.14 High Risk Fraud Area Support for CMS Field Offices |
| BI Edits Report |
| This is a report to the CMS FO on workload, edit effectiveness, appeals/reversals information, and savings. |
| Project Officer and CMS FO |
| No later than the 10th of the following month. |
| Quarterly |
| OFM/PIG/DBIMO |
| C.7.14 High Risk Fraud Area Support for CMS Field Offices |
| Overpayment Recoupment Report |
| This is a monthly report on all providers for which an overpayment has been identified and provides the CMS FO with a status of the identified overpayment. |
| Project Officer and CMS FO |
| No later than the 10th of the following month. |
| Monthly |
| OFM/PIG/DBIMO |
| C.7.14 High Risk Fraud Area Support for CMS Field Offices |
| Payment Suspension Report |
| This report provides the CMS FO with suspended payments for the month. |
| Project Officer and CMS FO |
| No later than the 10th of the following month. |
| Monthly |
| OFM/PIG/DBIMO |
| C.7.14 High Risk Fraud Area Support for CMS Field Offices |
| Fraud Prosecution Support Report |
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