Medicare Contractor Beneficiary and 
Provider Communications Manual 
Chapter 2 - Beneficiary Customer Services 
 
Table of Contents 
(Rev. 41, 02-08-19) 
Transmittals for Chapter 2 
10 - Introduction 
20  Beneficiary Customer Services (BCS) 
20.1  Escalation of Complex Beneficiary Inquiries to the MACs by the 
Beneficiary Contact Center (BCC) 
20.1.1  Next Generation Desktop (NGD) Training 
20.1.2  Disclosure of Information (Adherence to the Privacy Act and the 
Health Insurance Portability and Accountability Act (HIPAA) Privacy 
Rule) 
20.1.3  Screening of Beneficiary Complaints Alleging Fraud or Abuse 
20.1.4  Medicare Customer Service - Next Generation Desktop (MCSC-
NGD) Client Installation and Configuration Requirements 
20.1.5  Call Center User Group (CCUG) 
20.2  Complex Beneficiary Inquiries 
20.2.1  Handling Complex Beneficiary Inquiries 
20.2.2  Controlling Complex Beneficiary Inquiries 
20.2.3  E-mail and Fax Responses to Complex Written Beneficiary 
Inquiries 
20.2.4  Telephone Responses to Complex Beneficiary Inquiries 
20.2.5  Written Responses to Complex Beneficiary Inquiries 
20.2.6  Timeliness of Responses to Complex Beneficiary Inquiries 
20.3  Congressional Beneficiary Inquiries 
20.4  Surveys 
20.5  Urgent Need Regional Offices Casework 
  10 - Introduction 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
This chapter contains general instructions and requirements for the Fee-for-Service 
Medicare Administrative Contractors (MACs).  While the Centers for Medicare and 
Medicaid Services (CMS) have separately contracted for direct beneficiary 
communication with the Beneficiary Contact Center (BCC) contractor, MACs receive 
complex beneficiary inquiries from the BCC and Regional Offices (ROs) in accordance 
with National Operating Procedure NP 1.0 (complex inquiries), for  response.  As a 
result, MACs are required to respond to complex beneficiary inquiries.  This chapter 
provides instructions and guidance for MACs in handling, controlling, and responding to 
complex beneficiary inquiries, including Congressional inquiries written on behalf of 
beneficiaries. 
 
20 - Beneficiary Customer Services (BCS) 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
CMSs goal is to continuously improve the Medicare experience through the delivery of 
high quality and cost-effective customer service.  The CMS vision is for customer 
service to be responsive to the needs of diverse groups, a trusted source of accurate and 
relevant information, convenient and accessible assistance, and courteous and 
professional.  The following guidelines are designed to help MACs to ensure CMS goal 
and vision are met. 
 
20.1 - Escalation of Complex Beneficiary Inquiries to the MACs by the 
Beneficiary Contact Center (BCC)  
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
The BCC Customer Service Representatives (CSRs) escalate any complex beneficiary 
inquiries that they receive to the appropriate MAC through the Next Generation Desktop 
(NGD) in accordance the Complex Inquiry Escalation National Operating Procedure, NP 
1.0.  This procedure can be found at 
https://trainingresources.tanagerinc.com/MTKRSite/index.htm, under the National 
Operating Procedures section. 
 
20.1.1 - Next Generation Desktop (NGD) Training 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
The development of the NGD training materials will be done by CMS and it is not 
expected that there will be any costs to the MACs to use these training materials. 
Standardized training materials and other training information is available at the 
following Website:  
https://trainingresources.tanagerinc.com/MTKRSite/index.htm, under the All Learning 
Resources section.  MACs shall check this website monthly for updated training 
materials. 
  20.1.2 - Disclosure of Information (Adherence to the Privacy Act and 
the Health Insurance Portability and Accountability Act (HIPAA) 
Privacy Rule) 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
MACs shall protect the confidentiality of Medicare beneficiary personally-identifiable 
information (PII) and protected health information (PHI) in accordance with the Privacy 
Act of 1974 and the HIPAA of 1996. 
 
20.1.3 - Screening of Beneficiary Complaints Alleging Fraud or Abuse 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
The BCC will complete the first-level fraud/abuse screening (see IOM Pub. 100-08 
Medicare Program Integrity Manual (PIM)), Chapter 4, 4.6-4.6.2). 
 
Candidate cases that merit second-level screening will be forwarded to the appropriate 
MAC through NGD as a complex beneficiary inquiry in accordance with National 
Operating Procedure NP 1.0.  MACs shall follow the instructions in IOM Pub. 100-08 
Medicare PIM, Chapter 4, sections 4.6-4.6.2 for working these cases. 
 
20.1.4 - Medicare Customer Service - Next Generation Desktop (MCSC-
NGD) Client Installation and Configuration Requirements 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
MACs shall meet the following hardware, software, and installation instructions for the 
MCSC-NGD equipment. 
 
Minimum Hardware and Software Requirements: 
 
Minimum Hardware and Software Requirements for an NGD Personal Computer  
Processor:  500MHz PII or comparable AMD 
800MHz Celeron or comparable AMD 
Disk Space:  100MB available 
Memory:  288 MB for Windows XP 
Operating  Windows XP Service Pack 2 or later  
 
System: 
Browser:  Internet Explorer 6.0 - Service Pack  1 with Cumulative security update for SP 1 (KB867801) or 
above 
NOTE: More than one instance of NGD open at a time is not supported. 
Internet Explorer 8.0 with MS10-002: Cumulative security update 
NOTE: More than one instance of NGD open at a time is not supported. (i.e. 
can have only one active NGD session per IE 8 instance. ) 
Java:  Sun J2SE v1.5 or higher Java Runtime Environment (JRE).  The Sun J2SE 
can be downloaded from Suns web site at http://java.sun.com.  Do not 
download the Software Development Kit (SDK).  Installation instructions are 
on this site.  Monitor:  21 
Pointing Device:  Mouse with scroll 
Network  Network Interface Card compatible with the call center LAN, which will 
Interface:  ultimately allow workstation access to CMSNET 
Word Processor:  Microsoft Office 2002 (or higher version)  Required only for generation of 
correspondence. 
Viewers:  Microsoft Word Viewer (provided free by Microsoft) and Adobe Acrobat 
Reader (v4.05 or v5.0 free from Adobe) are required. 
 
Desktop Configuration: 
 
Note: You must set the following configurations in the users profile.  This can be done 
by logging into the workstation as the user and making the changes. 
 
General Desktop Configurations: 
 
General Desktop Configurations  How to Configure 
Set the screen resolution to 1024 X  Select Display from the control panel, then   the 
768 pixels  settings tab.  This can be set in the Screen Resolution 
field. 
Create a shortcut to the desktop  The URL should start with https:// and end with 
/fins.enu/ 
Please provide your IT person with  Please contact your IT Dept. to use PSS you have to be 
this information for the PSS Site  able to telnet to port 443 on the IP address of 
  32.91.253.217. 
 
command - telnet 32.91.253.217 443  This is not an 
internet connection.  This needs to route out of your 
CMSNet connection. 
 
General Internet Explorer Configurations: 
 
Note: Make the following Internet Explorer settings changes by selecting Internet 
Options under Tools in the browser. 
 
Internet Explorer Configurations  How to Configure 
Configure IE to automatically check  Click Settings on the General tab, then select 
for newer versions of stored pages.  Automatically 
Increase the Amount of disk space to  Click Settings on the General tab, then increase the 
use for the Temporary Internet files  disk space size 
folder to at least 150 MB. 
Delete the XRPC Class file and the  Click Settings on the General tab, then View Objects to 
Winhook Class file if they exist.  get to these files 
Add the necessary Sites to the  Varies depending on network topology. 
appropriate web content zone list in  the Security tab. 
Enter the appropriate address in the  Varies depending on network topology. 
Proxy Settings exceptions if necessary. 
 
Internet Explorer Advanced Tab  Selected/Deselected 
Settings 
Disable Script Debugging  Selected 
Do not save encrypted pages to disk  Deselected 
Reuse windows for launching  Deselected 
shortcuts 
 
 Internet Explorer Security Settings: 
 
Note: The following Security Settings for the web content zones (under Custom Level) 
must be set.  These are also accessible by selecting Internet Options under Tools in the 
browser. 
Note: The zone assigned to the following settings is dependent on the MACs network 
setup and recognition of the NGD application. If the MAC is treating the NGD 
application like an internet application, then the MAC will want to use the Trusted 
Sites zone and configure NGD as a trusted site. If the MAC is accessing NGD as though 
it is part of the Intranet, then the Intranet zone should be used. 
 
Note:  To run NGD in the Internet Security zone, it is required to set the "Download signed 
ActiveX controls" setting to Enable and to set the "Automatic prompting for ActiveX controls" 
to Enable. Without setting these properties as such, ActiveX controls cannot be downloaded, and 
the application will not function properly. Note that this requirement has not changed from 
Microsoft Windows XP SP1 to Microsoft Windows XP SP2. In Microsoft Windows XP SP2, 
however, the defaults for these settings have changed to Disable for sites running in the Internet 
Security zone.  
Note: The default setting for applications running in the Local Intranet Security zone and for 
Trusted sites are suitable for downloading of the Siebel ActiveX controls. If the Siebel 
application is in one of these Security zones, no action should be required to adjust this setting. 
 
Active X Controls and  Required  Comments 
Plug-ins 
Download signed Active X  Enable  Disabling Active X will remove 
Controls  application functionality such as 
Keyboard Accelerators 
Download unsigned ActiveX  Enable   
controls 
Initialize and script ActiveX  Enable   
controls not marked as safe 
Run ActiveX controls and  Enable   
plug-ins 
Script ActiveX controls  Enable    marked safe for scripting 
Automatic prompting for  Enable   
Active X controls 
 
 
Downloads  Required  Comments 
File download  Enable  Needed to allow attachment 
functionality 
Font download  Enable   
 
Java / Microsoft VM  Required  Comments 
Java permissions  Low Safety   
 
Java Console(for CTI  Required  Comments 
Toolbar) 
Use SSL 2.0 compatible  Disable  This setting can be found in 
ClientHello format 
Java Control Panel under 
Advanced > Security tab. 
Disable per Mitre. 
Use SSL 3.0  Disable  This setting can be found in 
Java Control Panel under 
Advanced > Security tab. 
Disable per Mitre. 
Use TLS 1.0  Enable  This setting can be found in 
Java Control Panel under 
Advanced > Security tab. 
Enable per Mitre. 
 
 
 Miscellaneous  Required  Comments 
Access data sources across  Prompt   
domains 
Allow META REFRESH  Enable  This setting is for Internet Explorer 6 
only. 
Display mixed content  Enable  This setting is for Internet Explorer 6 
only. May be required on a secured 
site that can display secured content 
and non-secured one. Note: This 
setting must be enabled in the 
Internet zone along with the 
selected zone being configured. This 
is the only exception in configuring 
zones. If the setting is not enabled  an additional pop-up error message 
will be displayed to the user. 
Dont prompt for client  Enable   
certificate selection when no 
certificate or only one 
certificate exists 
Drag and Drop or Copy and  Enable   
Paste files 
Installation of Desktop items  Prompt   
Launching programs and files in  Prompt  May be required if templates are 
an IFRAME  configured to use IFRAMEs 
Navigate sub-frames across  Enable   
different domains 
Software Channel permissions  Medium   
Safety 
Submit non-encrypted form data  Enable   
User persistence  Enable   
Use TLS 1.0  Enable   
Use SSL 2.0  Disable  Disable weak security cipher SSL v2 
per Mitre. 
Use SSL 3.0  Disable  Disable weak security cipher SSL v3 
per Mitre. 
 
Scripting  Required  Comments 
Scripting is used in relation to the Interaction Manager that handles the 
additional functionality provided by Siebel in High Interactivity mode 
such as the ability to edit within a list and many other functions.  There 
is also Siebel Applet Browser scripting in the Siebel object model for 
things like validations and calls to do things like interact with MS Word 
or export data. 
Active Scripting  Enable   
Allow paste operations via  Enable   
script 
Scripting of Java applets  Enable   
 
User Authentication  Required  Comments 
Logon  Automatic   
logon only in 
Intranet Zone 
 
Note:  When enabled, Pop-up Manager blocks most pop-up windows from appearing on the personal computer. End users 
and IT administrators must allow Siebel pop-ups to appear by including the NGD address in the Pop-up Manager's 
Allowed Sites list. It is a requirement that the NGD address be added to this list.  
Note: Sites in the Trusted Sites and Local Intranet zones never have their pop-up windows blocked. If the NGD address is 
in one of these security zones, no action is required to adjust this setting. 
   Connecting to the NGD Application: 
 
Note:  The Siebel High Interactivity Framework file and Smart Scripts can be downloaded and installed from any NGD 
8.1 environment.  The Siebel Browser Check can also be resolved when connected to any NGD 8.1 environment. 
 
Siebel High Interactivity Framework: 
 
The first time the client connects to NGD, the Siebel High Interactivity Framework is 
automatically downloaded and installed into the browser.  The Siebel High Interactivity 
Framework is also automatically downloaded and installed any subsequent time that the 
client connects to NGD without it installed.  The Siebel High Interactivity Framework is a 
necessary component in order to successfully login and use NGD. 
 
To install the Siebel High Interactivity Framework, the NGD user needs to have at least 
Power User level rights to their local machine.  When they next login to NGD, it will 
automatically be downloaded and installed. 
 
Some call centers restrict the rights that their users have to their local machines.  These 
sites may choose to pre-load the Siebel High Interactivity Framework component so that 
their users do not need Power User rights.  However, sites that choose to do this need to 
understand that if the Siebel High Interactivity Framework becomes corrupted, they will 
need to reinstall it.  Also, any future enhancements or versions to the Siebel High 
Interactivity Framework file will need to be loaded as well. 
 
To pre-load the Siebel High Interactivity Framework, a user with Power User or 
Administrative rights to the local machine must login to NGD from that machine. 
 
The recommended procedure is to grant Power User level rights to all NGD users.  Sites 
that choose to not grant Power User level rights to their users do so at their own risk.  The 
NGD Help Desk will not support the pre-loading of the Siebel High Interactivity 
Framework. 
 
Smart Script: 
 
The first time the Smart Script is activated in NGD; the Smart Scrip is automatically 
downloaded and installed into the browser.  The Smart Script is a necessary component in 
order to successfully use Smart Scripts in NGD. 
 
To install the Smart Script, the NGD user needs to have at least Power User level rights to 
their local machine.  When they next activate a Smart Script in NGD, it will automatically 
be downloaded and installed. 
 
Some call centers restrict the rights that their users have to their local machines.  These 
sites may choose to pre-load the Smart Script so that their users do not need Power User 
rights.  However, sites that choose to do this need to understand that if the Smart Script 
becomes corrupted, they will need to reinstall it.  Also, any future enhancements or 
versions to the Smart Script will need to be loaded as well.   
To pre-load a Smart Script, a user with Power User or Administrative rights to the local 
machine must login to NGD from that machine and activate a Smart Script. 
 
The recommended procedure is to grant Power User level rights to all NGD users.  Sites 
that choose to not grant Power User level rights to their users do so at their own risk.  The 
NGD Help Desk will not support the pre-loading of the Smart Script. 
 
Siebel Browser Check: 
 
Each time a client connects to NGD, the Siebel Browser Check applet checks the local 
browser for missing components (such as Suns JVM) and verifies the current 
configuration.  If there are any missing components or recommended changes the current 
configurations, the Siebel Browser Check dialog box will appear while the user is logging 
into NGD and offer to load the necessary components or change the recommended settings.  
You may instruct your users to select Auto Fix to automatically take the recommended 
action. 
 
Otherwise, if it is a setting that is not listed in this document and you do not want it 
changed (such as printing background colors and images), simply select the box next to 
Please do not warn me again about recommended settings and click Exit. 
 
 
 
Troubleshooting: 
  There are many erratic behaviors that can occur in NGD when the Siebel High 
Interactivity Framework file or Smart Script files become corrupted on the local machine.  
The best method to troubleshoot NGD issues is to begin by deleting the Siebel High 
Interactivity Framework and Smart Script files, then restarting the browser.  Those files 
will then need to be reinstalled (see section 3.1 and 3.2). 
 
To delete these files, do the following: 
  Select Tools => Internet Options from the browser menu 
  Click on the Settings button from the Temporary Internet Files section of the 
General tab 
  Click on View Objects from the Settings box 
  Select and delete the Siebel High Interactivity Framework and Smart Script files 
  Restart the browser 
Third Party Applications: 
 
Third party applications can interfere with the NGD application and cause it to freeze.  
Specifically, third party browser tool bars such as Comet Cursor, My Web, My Web 
Search, Google, Yahoo Toolbar, etc., as well as memory defrag (scrubbers) tools need to 
be removed.  Be aware that any third party application (such as call monitoring software) 
can interfere with NGD.  The NGD team will ask for third party applications to be 
removed if they discover that it is interfering with NGD. 
 
20.1.5 - Call Center User Group (CCUG) 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
MACs are required to participate in CCUG calls. The CCUG sessions provide a forum 
for CMS to discuss new and ongoing projects related to telephone customer service, for 
MACs to surface issues for CMS resolution, and call centers to share best practices in 
telephone customer service delivery. The call center manager or a designated 
representative shall participate at a minimum. 
 
20.2 - Complex Beneficiary Inquiries 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
Although MACs may receive beneficiary inquiries (letters, faxes, e-mails, and, rarely, 
telephone calls) through a number of portals, under the current design, the MACs are 
responsible for responding only to the complex beneficiary inquiries that are referred to 
them by the  (BCC) or the CMS ROs.  If MACs receive beneficiary inquiries that are of a 
general nature, such as, specific billing questions and questions about claims, medical 
records, or expenses. MACs shall refer the inquiring beneficiaries to the BCC at 1-800-
MEDICARE, or TTY # 1-877-486-2048.  MACs may also provide the beneficiaries with 
the address to which they may send correspondence: Centers for Medicare & Medicaid 
Services, P.O. Box 39 Lawrence, KS 66046. 
  20.2.1 - Handling Complex Beneficiary Inquiries 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
Complex beneficiary inquiries will be identified and referred to the MACs by the BCC or 
the ROs via NGD and may include, but are not limited to, telephone, written, and e-mail 
inquiries.  Once a complex beneficiary inquiry is referred to a MAC, the Provider 
Relations Research Specialists (PRRS) shall take ownership of the inquiry and be 
accountable for its resolution.  While the PRRS is held accountable for the response, the 
MAC may use other resources to develop the response, as appropriate. If PRRS transfers 
a complex beneficiary inquiry to a MAC department that has its own separate control 
process and timeliness standards (e.g., appeals), PRRS may close the inquiry in NGD.  
PRRS will document reliable and accurate information into the resolution details field, 
including guidance on how the inquirer/beneficiary can contact the MAC regarding the 
nature of the case (e.g., checking the status, asking follow-up questions).  The MAC shall 
respond directly to the beneficiary via telephone, written mail, fax, or e-mail and 
document the response in NGD.  Complex inquiries from beneficiaries shall receive the 
same priority and attention as complex inquiries from providers. 
 
The MAC shall have adequate language capabilities (English, Spanish, and TTY/TDD) to 
handle written and telephone communications with beneficiaries. 
 
The MACs shall not be required to install a separate TTY/TTD for complex beneficiary 
inquiries. 
 
The MAC shall obtain foreign language support service by contract for languages other 
than Spanish. 
 
Additionally, the MAC shall fog written responses for reading level (8th grade or less). 
 
The MAC shall provide feedback via NGD to the BCC identifying inappropriate referrals 
to the PRRS (such as general or routine inquiries that should have been handled by the 
BCC).  Every beneficiary shall receive direct, final responses to their complex inquiries 
that accurately and completely address the issues contained in the inquiries.  This extends 
to an overall approach to beneficiary inquiry handling that aims to result in a high 
standard of accuracy, professionalism and timeliness. 
 
20.2.2 - Controlling Complex Beneficiary Inquiries 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
The MACs shall control all complex beneficiary inquiries until they are closed by the 
PRRS. NGD will be maintained with accurate information so that if the beneficiary calls 
the BCC for information related to the initial inquiry, the BCC can address status and 
outcome and determine if additional follow up is necessary. 
 
Unless they meet the exception for second level Benefit Integrity escalations described in 
section 20.1.3, inquiries referred to other MAC departments by the PRRS may close the  inquiry in NGD as long as accurate and reliable information is documented in the 
resolution details field, including the nature of referral (e.g., appeals, MSP, etc.). 
 
20.2.3 - E-mail and Fax Responses to Complex Written Beneficiary 
Inquiries 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
In some cases, complex written beneficiary inquiries can be responded to by e-mail or 
fax. Since both represent official correspondence with the public, it is paramount that 
MACs use sound e-mail and fax practices and proper etiquette when communicating 
electronically.  MACs shall ensure that e-mail and fax responses follow the same 
timeliness and quality guidelines that pertain to all written inquiries.  Responses that 
contain financial or PHI shall be transmitted in accordance with the CMS Acceptable 
Risk Safeguard Controls for Secure Communications and not sent by e-mail.  When 
responding via fax, MACs shall first confirm the fax number with the intended recipient.  
If the e-mail or fax response contains financial, or PHI, the response may be mailed in a 
hardcopy format to the beneficiary or a telephone response may be used.  E-mail content, 
as well as attachments to e-mails, must be Section 508 compliant.  (See 
http://www.cms.gov/web/508/accessiblefiles/checklists.html  for information about 
Section 508 compliancy). 
 
20.2.4 - Telephone Responses to Complex Beneficiary Inquiries 
(Rev. 41; Issued: 02-08-19; Effective: 03-12-19; Implementation: 03-12-19) 
 
The term Medicare beneficiary identifier (Mbi) is a general term describing a 
beneficiarys Medicare identification number. For purposes of this manual, Medicare 
beneficiary identifier references both the Health Insurance Claim Number (HICN) and 
the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition 
period and after for certain business areas that will continue to use the HICN as part of 
their processes. 
 
MACs may respond to complex written beneficiary inquiries by telephone if, in their 
discretion, MACs determine that a telephone response is appropriate. 
 
For tracking and evaluation purposes, MACs shall develop a report of contact for each 
telephone response to a complex written beneficiary inquiry.  The report of contact shall 
be retained in the same manner and time frame as written responses to complex written 
beneficiary inquiries.  All reports of contact shall contain the following information: 
 
  Beneficiary name;  
  Telephone number;  
  Medicare beneficiary identifier;  
  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); and  
  Name of the PRRS correspondent who handled the inquiry 
 
If the beneficiary requests a copy of the report of contact, a response letter containing all 
the information in the Summary of Discussion shall be sent.  MACs may send the 
information via e-mail or fax if requested by the beneficiary and if the response does not 
contain any financial or PHI.  It is not acceptable to send the report of contact itself.  All 
timeliness and quality guidelines for a written response apply to the response containing 
the Summary of Discussion. 
 
If the MAC cannot reach the beneficiary by telephone, the MAC shall develop a written 
response.  It is not acceptable to leave a message/response on the beneficiarys voicemail 
containing financial, PII, or PHI. 
 
20.2.5 - Written Responses to Complex Beneficiary Inquiries  
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
MACs shall ensure that the written responses to complex beneficiary inquiries are 
accurate, complete, responsive, clearly written and presented in a professional manner. 
 
Written responses to complex beneficiary inquiries shall adhere to the basics of the Plain 
Writing Act of 2010, to the extent practicable.  The Plain Writing Act of 2010 requires all 
federal agencies and, by extension, their contractors to use plain writing in any document 
that (1) is necessary to obtain a federal benefit or service, (2) gives information about a 
federal benefit or service, and/or (3) explains how to comply with federal requirements.  
MACs shall refer to the document entitled, Toolkit for Making Written Material Clear 
and Effective, for assistance in meeting the requirements of the Plain Writing Act of 
2010.  The Toolkit is a health literary resource from CMS that consists of 11 parts.  It is 
available at http://www.cms.gov/Outreach-and-
Education/Outreach/WrittenMaterialsToolkit/index.html. 
 
In addition, MACs shall use the CMS Writing Guide to assist in the preparation of 
written responses to complex beneficiary inquiries.  The Writing Guide can be found on 
the Quality Written Correspondence Monitoring (QWCM) website at: 
https://www.qwcmscores.com/Docs/WritingGuideFINAL.pdf. 
 
Because the Toolkit and the CMS Writing Guide cannot possibly address every issue 
encountered in responding to complex written beneficiary inquiries, MACs may also use 
other resources (e.g., grammar guides) to supplement their writing process. 
 
20.2.6 - Timeliness of Responses to Complex Beneficiary Inquiries 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
MACs shall provide clear and accurate responses to complex beneficiary inquiries within 
25 business days for at least 75 percent of inquiries referred by the BCC or the CMS  ROs; and within 45 business days for 100 percent of all inquiries referred by the BCC or 
the CMS ROs.  
 
This timeframe begins the day the inquiry is originally received in NGD (transferred into 
NGD) and ends the day the MAC sends the final response.  For Benefit Integrity Unit 
escalations, the MAC shall consider the action complete and close the complex inquiry in 
NGD when the Benefit Integrity Unit referral is placed into the second-level screening 
work flow, and not when the second-level screening is complete. 
 
For those complex beneficiary inquiries that cannot be answered in final within 45 
business days, MACs shall send an interim response acknowledging receipt of the inquiry 
and explaining the reason for the delay.  When possible, inform the beneficiary about 
how long it will be until a final response will be sent.  Sending an interim response does 
not resolve the issue and the inquiry is not considered closed until the final response is 
sent. 
 
The final response shall be sent within 5 business days after receipt of the needed 
information.  Any interim responses for complex beneficiary inquiries will count toward 
the MACs overall allowance of no more than 5 percent of interim responses for the 
universe of complex beneficiary inquiries.  Responses to complex beneficiary inquiries 
shall be documented in NGD. 
 
20.3  Congressional Beneficiary Inquiries 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
Please refer to the Medicare Contractor Beneficiary and Provider Communications 
Manual, Chapter 6, Provider Customer Service Program "Congressional Inquiries 
Timeliness." 
 
20.4 - Surveys 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
CMS may require periodic surveys of customer service operations to be completed by 
each contractor within the time frames and in areas indicated on the specific notice. 
Examples include staffing profiles and training needs. 
 
20.5  Urgent Need Regional Offices Casework 
(Rev. 33, Issued: 10-02-15, Effective: 11-02-15, Implementation: 11-02-15) 
 
The MAC shall provide a direct point of contact (POC) to CMS ROs for the purposes of 
assisting them in resolving urgent need beneficiary inquiries involving any aspect of the 
Medicare Parts A and B programs.  An urgent need inquiry is one in which the 
beneficiary is unable to access medically necessary medical services, equipment and/or 
supplies in a timely manner; and without those services the beneficiarys life is 
endangered, medical condition will deteriorate and/or pain or discomfort will increase.  
The CMS ROs will contact the MAC for assistance in resolving an urgent need inquiry  through a prearranged contact that includes an email address, telephone, and fax number.  
The MAC POC shall coordinate resolution of the problem and involve appropriate 
functional areas within the MAC as necessary.  The RO will relay the resolution directly 
to the beneficiary. Transmittals Issued for this Chapter 
Rev #  Issue Date  Subject  Impl Date  CR# 
R41COM 02/08/2019  Update to Publication (Pub.) 100-09 to  03/12/2019 11059 
Provide Language-Only Changes for the New 
Medicare Card Project 
R33COM 10/02/2015  Medicare Contractor Beneficiary and Provider 11/02/2015 9000 
Communications Manual Beneficiary 
Customer Services Pub. 100-09 Chapter 2- 
Update 
R12COM 07/15/2005  Next Generation Desktop (NGD) Testing  08/15/2005 3493 
Requirements 
R11COM 06/03/2005  FY 2005Beneficiary Telephone Customer  07/05/2005 3737 
Services Replaced by Transmittal 11 
R10COM 05/27/2005  FY 2005Beneficiary Telephone Customer  06/27/2005 3737 
Services Replaced by Transmittal 11 
R08COM 02/18/2005  Medicare Beneficiary Call Centers Will Begin 03/14/2005 3706 
Offering Preventive Services Information 
R05COM 04/23/2004  Manual Instruction for Update Beneficiary  05/24/2004 3097 
Services Sections 5104 (MCM) and 2958 
(MIM), and Beneficiary Services Section 20 
of the Internet-Only Manual (IOM) 
R03COM 12/09/2003  Renumbering Chapters 2 through 5 and  N/A  N/A 
Revision of Chapter 4 
R01COM 10/01/2003  Initial Issuance of Chapters 1 through 5  N/A  N/A 
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