Medicare Administrative Contractor (MAC)  
Beneficiary and Provider Communications 
Manual
 
Chapter 6 - Provider Customer Service Program 
 
Table of Contents 
(Rev. 10900, 08-11-21) 
 
Transmittals for Chapter 6 
 
10  Introduction to the Provider Customer Service Program (PCSP) 
            10.1  PCSP Electronic Mailing Lists 
10.2  PCUG Call 
            10.3  POE, PCC and PSS Activities in the PCSP 
10.4  Partners in Progress Meeting 
20  Provider Outreach and Education (POE) 
20.1  Internal Development of Provider Issues 
20.2 - Partnering with External Entities and with Other MACs 
20.3 - Data Analysis - Overall 
20.3.1 - Analysis of Improper Payments Data 
20.3.2 - Analysis of Error Rate Reduction Data 
20.3.3 - Analysis of Provider Inquiries 
20.3.4 - Analysis of Claims Submission Errors 
20.3.5 - Analysis of Errors Regarding Medicare Policies 
20.3.6 - Analysis of Medical Review Referrals 
20.4  Provider Education 
20.4.1 - Provider Bulletins/Newsletters 
20.4.2 - Direct Mailings for the PCSP 
20.4.3 - Training for New Medicare Providers 
20.4.4 - Training Tailored for Small Medicare Providers 
20.4.5 - Educational Topics 
20.4.5.1  Local Coverage Determinations (LCDs) 
20.4.5.2 - Education Resulting from MR Referrals 
20.4.5.3 - Medicare Preventive Service Benefits 
20.4.5.4 - Electronic Claims Submissions 
20.4.5.5 - Remittance Advice (RA) 
20.5  POE Materials 
    20.6  Regular Meetings 
20.6.1  POE Advisory Groups (POE AGs) 
20.6.2  "Ask-the-Contractor" Teleconferences (ACTs) 
20.7 - POE Reporting 
20.7.1 - Provider Service Plan (PSP) 
20.7.2  Provider Customer Service Program Activity Report (PAR) 
20.7.3   Discretionary Reporting 
20.8  Charging Fees to Providers for Medicare Education and Training 
20.8.1  No Charge 
20.8.2  Fair and Reasonable Fees 
20.8.2.1  Fees for Materials Available on MACs'' Provider Education 
Websites 
20.8.2.2  Fees for Education and Training Activities 
20.8.2.3 - Fees for Videotapes or Recordings of Education and Training 
Activities 
20.8.3  Prohibitions 
20.8.4  Reimbursement from Providers for POE Staff Attendance at Provider 
Meetings 
20.8.5  Excess Revenues from Provider Participant Fees 
20.8.6  Refunds/Credits for Cancellation of Education and Training Activities 
20.8.7 - Considerations and Recordkeeping for Fee Collection 
30 - Provider Contact Center (PCC) 
30.1 - PCC Closures 
30.1.1 -  Pre-Approved PCC Closures 
30.1.2  Planned PCC Training Closures not Pre-Approved PCC Closures 
30.1.3  Emergency and Similar PCC Closures 
30.2 - CSR Equipment Requirements  
          30.3  Inquiry Triage Process 
30.3.1 - Responding to Coding Questions  
30.4 - Provider Telephone Inquiries  
30.4.1 - Guidelines for Provider Walk-In Service 
            30.4.1.1- Emergency Toll-Free Line 
30.4.2 - Teletypewriter (TTY) Lines 
30.4.3 - Inbound Calls 
30.4.4  Troubleshooting PCC Service Interruptions 
30.4.5 - Requesting Changes to Telephone Configurations 
30.4.6 - Hours of Operation 
30.4.7 - Providing Busy Signals 
30.4.8 - Queue Message 
    30.4.9 - Provider Telephone Line Staffing 
  30.4.9.1 - CSR Sign-in-Policy 
  30.4.9.2 - CSR Identification to Callers 
30.4.10 - Monitoring CSR Calls 
  30.4.10.1 - Quality Call Monitoring (QCM) 
  30.4.10.2 - Quality Assurance Monitoring (QAM) 
  30.4.10.3 - Remote Monitoring 
30.4.11 - Disaster Recovery Plan 
30.4.12 - Guidelines for High Quality Responses to Provider Telephone Inquiries 
  30.4.12.1 - Telephone Response Quality Monitoring Program 
30.4.12.2 - Telephonses to Provider Inauiries --QCM Program Minimum 
Requirements 
30.4.12.3 - Recording Calls 
30.4.12.4 - QCM Calibration 
       30.5 - Provider Relations Research Specialists (PRRS) 
30.5.1 - Complex Provider Inquiries 
30.5.2 - Complex Beneficiary Inquiries 
30.5.3  Duplicate Inquiries 
30.5.4 - Telephone Responses to Provider Written Inquiries 
30.5.5  Electronic Responses to Provider Written Inquiries 
30.5.6 - Check Off Letters 
30.5.7 - Guidelines for High Quality Responses to Provider Written Inquiries 
30.5.8  Stock Language/Form Letters 
30.5.9 - Provider Written Response Quality Monitoring Program 
30.5.9.1  Written Responses to Provider Inquiries -- QWCM Program 
Minimum Requirements 
30.5.9.2  QWCM Calibration 
            30.5.10 - Replying to Correspondence from Members of Congress 
      30.6 - Provider Inquiry Tracking 
30.6.1 - Updates to the CMS Standardized Provider Inquiry Chart 
      30.7 - Fraud and Abuse 
30.7.1 - Complex Provider Inquiries 
30.7.2 - Complex Beneficiary Inquiries 
30.8 - Surveys 
30.8.1 - Provider Satisfaction Survey 
30.8.2 - Telephone Satisfaction Survey 
30.8.3 - Provider Education Website Satisfaction Survey 
30.9 - Fraud and Abuse 
40 - PCSP Staff Development and Education 
40.1  POE Staff Training 
40.2 - PCC Staff Development and Training 
    40.2.1 - Required Training for PCC Staff 
40.2.2 - PCC Training Program 
40.2.2.1 - PCC Training Closure Determination 
40.2.2.2 - Provider Complaints about PCC Training Time Closures 
40.2.2.3  Provider Notification of PCC Training Closures 
40.2.2.4 - PCC Staff Feedback and MAC Evaluation of PCC Staff 
Training 
40.2.2.5 - PCC Training Documentation 
50 - Provider Self-Service (PSS) Technology 
50.1 - Interactive Voice Response (IVR) System 
50.2 - Provider Education Website 
50.2.1 - General Requirements 
50.2.2 - Webmaster and Attestation Requirements 
50.2.3 - Feedback Mechanism 
50.2.4 - Contents 
50.2.4.1 - Dissemination of Information from CMS to Providers 
50.2.4.2 - Frequently Asked Questions (FAQs) 
50.2.4.3 - Quarterly Provider Update (QPU) 
50.2.4.4 - Web-based Provider Educational Offerings 
      50.2.4.5 - Provider Claims Payment Alerts 
50.2.5 - Provider Education Website Promotion 
50.3  Electronic Mailing List 
50.3.1 - Targeted Electronic Mailing Lists  
50.3.2 - Electronic Mailing List Promotion 
50.4 - Social Media 
50.5 - MAC Internet-based Provider Portals 
50.5.1 - Internet-based Provider Portal Service Interruptions 
60 - PCSP Performance Management 
60.1 -  Provider Satisfaction Survey 
60.1.1 MAC Survey Participation Requirements 
60.1.2  Continuous Improvement 
60.1.3  Closed-Loop Ticketing 
60.1.4  Survey Response Prohibition 
60.1.5 MCE User Guide 
60.1.6 - Third-Party Contractor Platform System Users 
60.2 - Telephone Standards 
70 - PCSP  Performance Management 
70.1 - POE  Electronic Mailing Lists Subscribership  
70.2 - Provider Customer Service Program Contractor Information Database (PCID) 
70.2.1  Call Completion 
    70.2.2 - MAC Contract and PCSP Data to be Reported in PCID 
70.2.3  Additional Data to be Reported Monthly in PCID and Reporting Due 
Dates 
                       70.2.4  Callbacks 
                       70.2.5  QCM Performance Standards 
                       70.2.6  QAM (Telephone) Performance Standard 
 
70.3 -  Quality Call Monitoring (QCM) 
          70.3.1 Access to QCM 
                      70.3.2  Timeliness of Responses to Written Provider Inquiries 
               70.3.2.1 - Timeliness of Responses to General Provider Inquiries 
               70.3.2.2 - Timeliness of Responses to Complex Provider Inquiries (PRRS) 
 70.3.2.3 - Timeliness of Responses to Complex Beneficiary Inquiries                                              
(PRRS) 
                                   70.3.2.4 - Timeliness of Responses to Congressional Inquiries 
         80 - Disclosure of Information 
             80.1  PIES 
                                 80.1.1 - Access to PIES 
             80.1.2 - Due Date for Data Submission to PIES 
             80.1.3 - Data to be Reported Monthly in PIES 
                       80.2  PCID 
80.2.1 - Access to PCID 
80.2.2 - MAC Contract and PCSP Data to be Reported in PCID 
80.2.3 - Additional Data to be Reported Monthly in PCID and Reporting                               
Due Dates 
                                               80.2.3.1  Inquiry Tracking Data to be Reported in PCID 
                                     80.2.3.2  PCC Training Closure Information to be Reported in      
                         PCID                                                                                                                 
                           80.2.3.3  POE Data to be Reported in PCID 
80.2.3.4  Provider Electronic Mailing List Subscriber  
      Data to be Reported in PCID 
                          80.2.3.5  Special Initiatives Activities to be Reported in PCID 
                                               80.2.3.6  Emergency and Similar PCC Closure Data to be       
              Reported in PCID   
                                               80.2.3.7  Telecommunications Service Interruptions to be    
                                                                Reported in PCID           
                           80.2.3.8  Provider Internet-based Portal Service Interruptions to  
                                                                be Reported in PCID  
80.2.3.9  Provider Internet-based Portal Functionality to be       
Reported in PCID 
80.2.3.10  Provider Education Website Analytic Data to be    
Reported in PCID 
                  80.2.3.11  Social Media Analytic Data to be Reported in PCID 
                  80.2.3.12  Direct Mailing Information to be Reported in PCID 
80.3 QCM 
                      80.3.1 - Access to QCM 
80.4 QWCM 
                80.4.1 - Access to QWCM 
90 - Disclosure of Information 
 
Provider Customer Service Program 
(Rev.10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
NOTES: 
 
1.  In this chapter, the term provider includes all Medicare providers and suppliers 
unless specifically noted otherwise.  In section 20 of this chapter, the terms 
provider of services and suppliers are used to convey specific requirements of 
the mandated improper payment outreach and education program. 
 
2.  In this chapter, the term Medicare Administrative Contractor (MAC) means 
all MACs (A/B, HH+H, and DME), unless specifically noted otherwise, in 
accordance with each MACs Statement of Work (SOW). 
 
3.  In this chapter, the term Customer Service Representative or CSR refers to all 
MAC staff who handle telephone, written, PRRS or Congressional inquiries.  
Where a requirement applies to one group specifically that group will be spelled 
out as follows:  Telephone CSR, Written CSR, PRRS or Congressional CSR.  
 
4.  Deliverables, Deliverable dates, and requirements in a MACs SOW supersede any 
such Deliverables, Deliverable dates, and requirements stated in this chapter, should 
the documents conflict.  Unless stated otherwise, MACs shall continue to send 
contract Deliverables to the appropriate Deliverables mailbox. 
 
5.  The information in this chapter is applicable only to the Provider Customer Service 
Program at the MACs, unless specifically noted otherwise. 
 
10  Introduction to Provider Customer Service Program (PCSP) 
(Rev.10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
The Centers for Medicare & Medicaid Services (CMS) requires all MACs have a PCSP to help 
providers understand and comply with Medicares operational processes, policies, new 
initiatives, and billing procedures.  The PCSP serves to strengthen and enhance CMSs ongoing 
provider education efforts. The primary principle is to continuously improve Medicare provider 
satisfaction through the timely delivery of accurate and consistent information in a courteous and 
professional manner.  These practices will help providers understand, manage, and bill the 
Medicare Program correctly, and reduce the Medicare paid claims error rate and improper 
Medicare payments both nationally and for individual MACs. 
 
The PCSP integrates MAC provider inquiry and provider outreach and education activities 
creating a comprehensive program.  The PCSP shall be a trusted source of accurate and relevant 
    information, staffed with personnel who have technical and customer service expertise and 
experience to address various provider inquiries and to develop and deliver provider education.  
The PCSP consists of three major components: Provider Outreach and Education (POE), 
Provider Contact Center (PCC), and Provider Self-Service (PSS) Technology. 
 
10.1  PCSP Electronic Mailing Lists (Listservs) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Note:  The terms electronic mailing list and listserv are often used interchangeably.  
Electronic mailing list is more technically descriptive and is the preferred term of use in this 
chapter.   
 
1.  Provider Customer Service Program Contractor User Group (PCUG) electronic mailing 
list - MACs shall subscribe to the CMS PCUG electronic mailing list to receive important 
and timely information from CMS related to the PCSP, including CSR training materials 
and quality assurance program updates.  MACs shall not share information received on 
the PCUG listserv with providers unless directed to do so. MACs shall send an email to 
the Provider Services mailbox at providerservices@cms.hhs.gov to subscribe or 
unsubscribe to this electronic mailing list.  The email shall include the names and email 
addresses of the individuals who wish to subscribe or unsubscribe to the electronic 
mailing list.  At a minimum, the MAC POE manager, the MAC PCC manager, those 
managing PSS technology, and quality analysts shall subscribe to the electronic mailing 
list.  Additional MAC staff may also subscribe.  There is no limitation on the number of 
subscribers for any MAC. 
 
2.  MLN Connects  CMS utilizes an electronic mailing list in the form of a weekly 
newsletter named MLN Connects to send MACs important and timely information for 
them to share with their provider community, such as updates to the CMS website, 
provider education material, and copies of proposed and final regulations.  MACs shall 
subscribe to MLN Connects to get this information.  MACs shall send an email to 
MLNConnectsMAC@cms.hhs.gov to subscribe or unsubscribe to this electronic mailing 
list.  The email shall include the names and email addresses of the individuals who wish 
to subscribe or unsubscribe to the electronic mailing list.  In addition, the email shall 
identify a permanent corporate/resource box at the MAC.  The MAC staff noted in item 1 
above shall subscribe, as may additional MAC staff.  There is no limitation on the 
number of subscribers for any MAC. 
 
MACs shall subscribe to these electronic mailing lists within 30 business days after a new MAC 
contract award date or if there is a change in the MAC staff who are required to subscribe. 
 
MACs shall request to unsubscribe staff who have access to one or both of these electronic 
mailing lists before staff termination or end of employment. 
 
 
 
 
    10.2  Provider Customer Service Program User Group (PCUG) Call 
(Rev.10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS will hold monthly PCUG conference calls.  The call allows CMS to update MACs on 
issues, directives, and policies impacting the PCSP and provides a forum for MACs to ask 
questions and share ideas.  MACs shall ensure staff from their PCC, POE, and PSS functions 
attend each monthly PCUG call.  CMS strongly encourages MACs to submit agenda topics for 
consideration to the Provider Services mailbox at providerservices@cms.hhs.gov. 
 
10.3  Integration of Provider Outreach and Education (POE), Provider 
Contact Center (PCC) and Provider Self-Service (PSS) Activities in the PCSP 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Since the PCSP is an integration of POE, PCC and PSS activities, MACs shall regularly review 
their operations to find ways to integrate these activities and existing resources to provide a 
comprehensive PCSP for providers in their jurisdiction.  Examples include providing upcoming 
education information to CSRs so they can relay information to providers about how to access or 
register for upcoming provider training or available computer based-training.  Another example 
is to have telephone CSRs or the IVR system convey information about how to subscribe to the 
MACs electronic mailing list or to publicize the MACs provider education website while 
callers are on hold.  CMS encourages MACs to give opportunities to POE staff and PCC staff, 
including CSRs, to work together so both areas accomplish their respective tasks.  Such sessions 
could periodically occur during the regularly scheduled CSR training classes so MACs do not 
take additional time from PCC operations. 
 
In addition to working closely with PCSP staff, MACs shall coordinate internally with staff in 
appropriate areas (including personnel responsible for Medical Review (MR), Provider 
Enrollment (PE), Electronic Data Interchange (EDI)/systems, appeals, Medicare Secondary 
Payer (MSP), and program integrity) to share and communicate identified issues. At a minimum, 
the MACs shall hold periodic meetings with these various components to discuss any provider 
issues and potential resolutions. The MACs shall document these meetings and activities and 
provide this information to CMS upon request. 
 
MACs shall submit a high-level organizational chart for their PCSP to the Provider Services 
mailbox at providerservices@cms.hhs.gov.  MACs shall submit the chart within 60 calendar 
days after the cutover date of the MAC contract (if more than one cutover date, within 60 
calendar days after the earliest cutover date) or, if the information for the chart is not available at 
that time, within 7 calendar days after the information becomes available.  If a due date falls on a 
weekend or holiday, the chart is due by close of business on the next business day. MACs shall 
submit a revised organizational chart within 14 days of making changes. 
 
10.4 - Partners in Progress Meeting 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
At least once a year, CMS reserves the right to hold an in-person meeting with MAC staff.  The 
purpose of the conference is to discuss CMS priorities/initiatives; share best practices and 
    program successes; develop new and improved approaches for the PCSP; exchange information 
about PCSP issues; and allow MAC staff to network and identify opportunities for collaboration.  
 
MACs shall send representatives from all facets of the PCSP (PCC, POE and PSS). 
 
CMS expects this meeting to last from 2-4 days.   
 
20  Provider Outreach and Education (POE) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
The primary goal of the POE program is give Medicare providers the timely and accurate 
information they need to understand the Medicare Program, be informed about changes, and 
correctly bill.  POE is driven by educating providers and their staffs about the fundamentals of 
the Medicare Program, national and local policies and procedures, new Medicare initiatives, 
significant changes to the Medicare Program, and issues identified through analyses of such 
mechanisms as provider inquiries, claim submission errors, MR data, CERT data, and Recovery 
Auditor data. 
 
MACs shall disseminate information to their providers through outreach, education, training, 
technical assistance, or other activities to help reduce improper payments. Each MAC shall 
establish an improper payment outreach and education program that will expand and enhance 
efforts to reduce improper payments in accordance with guidance from CMS.  In particular, 
MACs shall analyze data in accordance with sections 20.3 of this chapter when developing their 
outreach and education program. 
 
MACs shall give priority to improper payment outreach and education program activities that are 
one or more of the following:  (a) are for items and services with the highest rate of improper 
payment; (b) are for items and services with the greatest total dollar amount of improper 
payments; (c) are due to clear misapplication or misinterpretation of Medicare policies; (d) are 
other types of errors that could be prevented through activities under the improper payment 
outreach and education program. 
 
MACs shall also give priority to improper payment outreach and education program activities for 
providers and suppliers with (a) the highest rate of improper payment, and (b) have the greatest 
total dollar amount of improper payments. 
 
MACs have discretion to deliver education using the most effective and efficient strategy and 
method to offer Medicare providers a broad spectrum of information about the Medicare 
Program. Clinical and non-clinical staff may deliver POE education to groups or to individuals 
through a variety of communication channels and mechanismsincluding Web, telephone, 
computer storage/read-only memory, educational messages on the inquiries line(s) and IVR, 
face-to-face instruction, web-based training, and presentations in classrooms and other settings. 
CMS encourages innovation as MACs identify provider educational priorities and delivery 
methods, including leveraging PCC and PSS resources to identify educational opportunities and 
expand delivery methods. 
 
    MACs shall use all strategies and methods to inform and educate providers of services and 
suppliers of (a) the most frequent and expensive payment errors over the previous quarter, (b) 
specific instructions regarding how to correct or avoid such errors in the future, (c) notice of new 
topics approved for audits conducted by Recovery Auditors under section 1893(b), (d) specific 
instructions to prevent future issues related to such new audits, and (e) other information as 
determined appropriate by CMS. 
 
MACs shall use existing CMS educational products, including Medicare Learning Network 
(MLN) products or content whenever possible in educating providers.  (See section 20.4 of this 
chapter.) 
 
20.1 - Internal Development of Provider Issues 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The POE staff may send a representative to the MACs Contractor Advisory Committee (CAC) 
as part of its identification and development of provider issues. (See Pub. 100-08, Medicare 
Program Integrity Manual, Chapter 13.) 
 
20.2 - Partnering with External Entities and with Other MACs 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall establish and maintain partnerships with external entities, as well as with other 
MACs, to facilitate the dissemination of Medicare information that will assist providers in 
submitting correct claims and in following regulatory requirements for documentation when 
ordering or referring certain items or services. 
 
MACs shall establish and maintain partnerships with external entities to help disseminate 
Medicare provider information.  Whenever feasible, events and activities shall be coordinated 
with other Medicare contractors and entities, including quality improvement organizations 
(QIOs), State Health Insurance Assistance Programs (SHIPs), and End Stage Renal Disease 
(ESRD) networks, as well as interested groups, organizations, and CMS partners.  In addition, 
MACs shall routinely and directly notify other interested entities of their upcoming provider 
education events and activities.  Partnership activities shall not take the place of MAC-led POE 
events but shall supplement them. 
 
Partnering entities may be other MACs, medical, professional or trade groups and associations, 
government organizations, educational institutions, trade and professional publications, specialty 
societies, and other interested or affected groups.  By establishing collaborative information 
dissemination efforts, providers will be able to obtain Medicare Program information through a 
variety of sources.  Partnering on collaborative provider information and education efforts may 
include, but are not limited to: 
 
1.  Including information from partners in newsletters or publications. 
 
2.  Reprinting and distributing (free of charge) provider education materials. 
 
    3.  Disseminating provider information or education materials at organization meetings and 
functions of partnering entities. 
 
4.  Scheduling presentations or classes for members of partnering entities. 
 
5.  Requesting information for Medicare providers be posted on the websites of partnering 
entities.  
 
6.  Helping partnering entities develop their own Medicare provider education and training 
material. 
 
7.  Partnering with other MACs to educate providers that may cross MAC jurisdictions. 
 
8.  Collaborating with other MACs to educate ordering or referring providers on such things 
as documentation requirements for items or services, such as orders or referrals for tests, 
imaging procedures, Durable Medical Equipment, Prosthetics, Orthotics and Supplies 
(DMEPOS), and home health services especially when the ordering or referring provider 
is in a different MAC jurisdiction than the servicing provider.  
 
MACs shall report information about their partnerships with external entities, specifically on 
partnerships related to education on items or services with the highest improper payment rate, in 
Provider Customer Service Program Customer Information Database (PCID) on a monthly basis.  
See section 80.2.3.3 of this chapter for more information on reporting requirements.  
 
MACs shall work with each other to establish and maintain, on a regular basis, collaborative 
relationships with other MACs for the purposes of developing and implementing outreach and 
education offerings to providers on Medicare Program requirements that cross their lines of 
business (Part A, Part B, HH+H, and DME).  The requirements for ordering home health 
services and DMEPOS are prime examples of two such collaborative efforts. MACs shall ensure 
their outreach and education plans include efforts related to: (1) educating physicians about the 
Medicare requirement when ordering home health services for people with Medicare and about 
the specific documentation requirements of those orders, and (2) educating physicians and 
clinicians who are permitted to order DMEPOS about the Medicare requirement when ordering 
DMEPOS for people with Medicare and about the specific documentation requirements of those 
orders.  
 
MACs shall report information about their collaborations with other MACs, specifically about 
their collaborations related to education on items or services with the highest improper payment 
rate, in PCID on a monthly basis.  See section 80.2.3.3 of this chapter for more information on 
reporting requirements.  
 
20.3 - Data Analysis - Overall 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall analyze all available data, such as CERT error rates, Recovery Auditor data, 
telephone, written and portal inquiries data, claims submission errors, claims payment errors, 
    appeals data, CSR feedback, MR referral data, MR targeted probe and educate data, satisfaction 
survey data, as well as feedback from other areas across the MAC, as they develop their 
education methodology. 
 
The data listed in this section shall not be construed as an all-inclusive list.  MACs shall use their 
discretion to determine if their PCSP would benefit from analysis of data not mentioned in this 
section. 
 
20.3.1 - Analysis of Improper Payments Data 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
To reduce improper payments, MACs shall analyze the following data as provided by the 
Recovery Auditors in reports in the Recovery Audit Contractor (RAC) Data Warehouse (see 
Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 Section 505):  (a) the 
providers in the MACs jurisdiction with the highest rate of improper payments; (b) the providers 
in the MACs jurisdiction with the greatest total dollar amounts of improper payments; (c) the 
items and services with the highest rates of improper payments in the MACs jurisdiction; (d) the 
items and services furnished responsible for the greatest dollar amount of improper payments in 
the MACs jurisdiction; and (e) other data CMS determines would assist in carrying out the 
program. 
 
20.3.2 - Analysis of Error Rate Reduction Data 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall implement a provider education plan that focuses on reducing the CERT error rate.  
MACs shall focus on data from the CERT and RAC programs, as appropriate.  Additionally, 
MACs shall use other data sources, such as provider inquiry tracking data and claims submission 
error data, as part of the analysis in developing their error rate reduction plan. 
 
CERT data, including the inpatient claims error rate, are primary sources of information to target 
education activities.  MACs shall utilize the reports accessible from these programs, using 
national data where available.  Local data shall be compiled in a way to identify which providers 
in a MACs jurisdiction may be driving any unusual patterns.  MACs shall consider other 
sources of data when evaluating the CERT findings in order to develop an educational plan. 
 
MACs shall ensure their CERT educational activities focus on existing CMS products and 
publications, including MLN products or content whenever practicable.  MACs shall be aware of 
the CERT materials available from CMS and suggest topics to CMS for MLN products or 
content.  (See section 20.4 of this chapter.) 
 
20.3.3 - Analysis of Provider Inquiries 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall maintain a provider inquiry analysis program to produce a monthly list of the most 
frequently asked questions (FAQs) beyond claims status and eligibility for telephone and written 
inquiries.  MACs shall use CMS information or instructions to classify or categorize provider 
    inquiries.  MACs shall develop and implement education to address the needs of providers as 
identified by this program.  MACs shall also use the results of their inquiry analysis program to 
develop and deliver training to their PCSP staff. 
 
20.3.4  Analysis of Claims Submission Errors 
(Rev .10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Claims submission errors are those that result in rejected, denied, or incorrectly paid claims.  
MACs shall maintain a provider data analysis program that produces a monthly list of the most 
frequent collective claims submission errors from all providers in their jurisdiction. This program 
shall include common and inadvertent clerical or administrative errors and other types of errors 
that could be prevented through outreach and education. Such data analysis may include 
identification of aberrancies in billing patterns within a homogeneous group, or detection of 
patterns within claims or groups of claims.  Data analysis itself may be undertaken as part of 
general surveillance and review of submitted claims, or may be conducted in response to 
information about specific problems stemming from complaints, provider input, alerts, or reports 
from CMS or other MACs. This information shall be used to develop and modify the provider 
education contained in MAC POE plans.  
 
20.3.5  Analysis of Errors Regarding Medicare Policies 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
MACs shall conduct an analysis of improper payment errors that are due to clear misapplication 
or misinterpretation of Medicare policies. 
 
20.3.6  Analysis of MR Referrals 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
In accordance with Pub. 100-08, Medicare Program Integrity Manual, Chapters 1 and 3, POE 
staff is responsible for providing education as a result of referrals from MR.  As part of this 
process, POE staff shall maintain information about referrals from MR, requests for education 
from providers, follow-up communication with MR, and disposition of problems referred from 
MR, including the type of education given.  (See section 20.4.5.2 of this chapter.) 
 
20.4 - Provider Education 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
To the extent practicable, MACs shall use CMS national educational materials (for example 
cms.gov content, MLN products or content and MLN Connects) in their POE activities. If a 
MAC plans to translate materials into another language, they must make CMS aware by sending 
an email to the provider services mailbox at providerservices@cms.hhs.gov with the subject line: 
MAC name  Language Translation. Note: this is for awareness not clearance. 
 
    MACs shall subscribe to the MAC-specific version of MLN Connects.  To subscribe, MACs 
shall send staff email addresses to MLNConnectsMAC@cms.hhs.gov. MACs are not required to 
subscribe to the MLN Products and MLN Matters electronic mailing lists to get and market 
MLN products and articles. 
 
Medicare Learning Network (MLN), MLN Connects and MLN Matters are registered 
trademarks of the U.S. Department of Health and Human Services (HHS) and brand names for 
official CMS provider educational products and services, outreach activities, and information 
resources designed to promote national consistency of Medicare provider information.  MLN 
products and services include: 
 
  Publications (Fact sheets, Educational Tools and Booklets) 
  MLN Matters Articles and Special Edition MLN Matters Articles 
  MLN Connects  
  Calls and webcasts 
  Web-Based Training courses 
  Videos 
  Electronic mailing lists 
  Social Media content 
 
MACs shall use these MLN products and content to deliver a planned and coordinated provider 
education program to give educational opportunities that accommodate health care 
professionals busy schedules with the least amount of disruption to their normal business 
operations.  MACs shall use MLN products or content for all educational topics and for 
specialty provider groups including, but not limited to, new Medicare providers and small 
Medicare providers.  MACs shall supplement MLN products or content and other CMS 
materials with specific information unique to their jurisdictions. 
 
MACs shall include or link to MLN products or content (where practicable) (See 
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNGenInfo/index.)  
 
MACs shall include the MLN Button on all provider education websites, displayed where 
providers would look for educational resources.  To access the MLN Button and for further 
information on the MLN Button, see https://www.cms.gov/Outreach-and-Education/Medicare-
Learning-Network-MLN/MLNProducts/MLN-Multimedia-Items/MLN_Web_Button.  (See 
section 50.2 of this chapter for additional provider education website requirements.) 
 
MACs shall send messages marketing the MLN through various distribution methods including, 
but not limited to, their provider education website, and shall have an MLN ad in all 
publications. 
 
MACs shall train their CSRs at least once per contract year on the MLN website and how to 
access and use MLN products or content, MLN Connects and MLN calls and webcasts. 
 
    If MACs identify a gap or lack of information about specific topics, they shall suggest topics for 
MLN Matters Articles, MLN calls or webcasts or other MLN products that may be useful in 
provider education.  MACs shall send suggestions to the MLN mailbox at MLN@cms.hhs.gov.  
 
20.4.1 - Provider Bulletins/Newsletters 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs may at their discretion, electronically distribute and post on their website provider 
bulletins/newsletters that contain Medicare Program and billing information.   
 
MACs shall encourage providers to obtain electronic copies of bulletins/newsletters and other 
notices through their provider education websites. However, MACs shall ensure that active 
providers without Internet access (if known by the MAC) shall receive paper provider 
bulletins/newsletters via U.S. Postal Service.  Active providers are those whose enrollment 
records in the Provider Enrollment, Chain and Ownership system (PECOS) are active. If 
providers who receive paper copies are interested in obtaining additional paper copies on a 
regular basis, MACs are permitted to charge a fee for this service.  The subscription fee shall be 
fair and reasonable and based on the cost of producing and mailing the publication. 
 
20.4.2  Direct Mailings for the PCSP 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
At the request of CMS, MACs shall print and distribute hardcopy mailings (known as direct 
mailings) to all or a subset of their active providers.  (See the definition of active provider in 
section 20.4.1 of this chapter.)  MACs shall follow the business requirements in the associated 
Change Request (CR) when determining the address to use for a direct mailing and for other 
instructional information.  A direct mailing may not be sent to the address of billing agencies or 
clearinghouses used by providers.   
 
For these mailings, MACs shall use the letterhead and envelopes typically used for provider 
correspondence.  In accordance with IOM Pub 100-09, Chapter 1, Section 20, all Medicare 
communications must include Medicare identification to distinguish Medicare correspondence, 
and establish program identity with physicians, suppliers and beneficiaries.  The word 
Medicare or the CMS alpha representation should be at least as large as the organizations 
identification, and in a location that gives at least equal prominence.  When possible CMS will 
send the direct mailing letter in Word format to allow MACs to set up the letters to allow the 
use of a window envelope. Unless otherwise instructed, MACs shall follow their internal 
procedures concerning undeliverable mail. 
 
When directed, MACs shall also post a link to the letter on their provider education website.  
 
MACs shall report direct mailing activities in accordance with Section 80.2.3.12 of this chapter.  
 
 
 
 
    20.4.3 - Training for New Medicare Providers 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall offer training tailored to the needs of new Medicare providers and billing staff.  
MACs shall use CMS-developed materials, including MLN products or content, to the extent 
practicable.  (See section 20.4 of this chapter.)  This training shall include fundamental Medicare 
policies, programs, and procedures and shall concentrate on and feature information on billing 
Medicare. 
 
20.4.4 - Training Tailored for Small Medicare Providers 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall tailor education to the needs of their small Medicare providers. Small providers are 
defined by law as providers with fewer than 25 full-time equivalent employees or suppliers with 
fewer than 10 full-time equivalent employees.  MACs shall use CMS-developed materials, 
including MLN products or content, to the extent practicable.  (See section 20.4 of this chapter.)  
This training may involve interactive communication such as face-to-face trainings or web-based 
tutorials or instruction.  CMS does not require MACs to identify or validate providers who meet 
the definition of small provider. 
 
Education and training of small providers may include the provision of technical assistance, such 
as review of billing systems and internal controls, to determine program compliance and to 
suggest more efficient and effective means of achieving such compliance.  Small provider 
technical assistance can also include educational seminars for groups of providers identified as 
having similar problems with their billing systems or internal controls. It also can include 
assistance from EDI support staff, since much of the billing system technical expertise at the 
MAC resides with that staff. 
 
20.4.5  Educational Topics 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall use their discretion to determine the educational topics most relevant to their 
provider population.  MACs shall use various sources of information, including provider 
feedback, policy and procedure changes, and MAC data analysis to determine these topics; 
however, at a minimum, MACs shall educate providers on the topics outlined in this section.  
MACs shall use CMS-developed materials, including MLN products or content, to the extent 
practicable.  (See section 20.4 of this chapter.) 
 
20.4.5.1  Local Coverage Determinations (LCDs) 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall educate their provider community on new or significantly revised final LCDs.  
MACs shall include pertinent information about the LCDs on their provider education website 
and as part of regular bulletin distributions (if published), including articles drafted by the MR 
personnel. 
 
    Clinical questions about the LCDs, such as the rationale behind coverage of certain items or 
services versus other similar ones, shall be directed to MR personnel who will respond in 
accordance with Pub. 100-08, Medicare Program Integrity Manual, Chapter 13. 
 
20.4.5.2 - Education Resulting from MR Referrals 
 (Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
In accordance with Pub. 100-08, Medicare Program Integrity Manual, Chapters 1 and 3, the 
MACs MR area shall analyze MR data and make two types of education referrals to POE:  
referrals resulting from probe reviews and priority referrals. 
 
Probe Review Referrals: When MR staff performs a probe review, the provider is notified about 
the review.  The notification letter may include an offer for provider education to address the 
issues found in the probe.  If education is requested by a provider in response to one of these 
letters, POE staff shall be responsible for providing this education.  The education can be of any 
type the MAC deems appropriate, including one-on-one training, referral of the provider to 
available web training, and upcoming workshops containing information on the topic.  The MAC 
shall ensure that staff has ready access to copies of the probe notification letters should a 
provider contact POE staff to request education. 
 
Priority Referrals: A priority referral results when MR staff believes education is important for a 
provider or small group of providers in order to prevent further errors and reduce fraud.  POE 
staff should collaborate with MR staff when evaluating these referrals to determine what type of 
education, if any, is appropriate and whether this education fits with the overall MAC strategy to 
reduce the error rate. 
 
The MAC is under no obligation to provide specific education in response to all MR referrals.  
The education provided as a result of MR shall be determined in the context of the MACs goal 
of reducing the error rate within the resources available.  The type of education and the 
involvement of clinical staff are at the discretion of the MACs.  MACs shall not charge for this 
education.  (See section 20.8.1 of this chapter.) 
 
POE staff shall ensure they provide timely feedback to MR staff about the disposition of the 
referral, including whether a provider requested education in response to a probe letter.  POE 
staff shall work with MR staff to develop an effective system of communication that, at a 
minimum, maintains information about referrals from MR staff, requests for education from 
providers, follow-up communication with MR staff, and disposition of problems referred from 
MR staff, including type of education given. 
 
20.4.5.3 - Medicare Preventive Service Benefits 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall promote to their provider community the use of preventive services and other 
benefits provided by the Medicare program to beneficiaries.  Information can be found at 
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/.  
 
    20.4.5.4 - Electronic Claims Submissions 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall conduct training for providers or their staff on electronic claims submissions. The 
MACs shall conduct training activities for providers to educate them on, and expand their use of, 
Medicare billing software and the EDI transactions supported by Medicare. If a MAC does not 
perform the EDI services for their contract, they may partner with the contractor responsible for 
EDI activities. This may include telling providers to contact EDI support staff directly for 
technical billing system assistance. DME MACs should direct suppliers how to contact the 
Common Electronic Data Interchange (CEDI). 
 
20.4.5.5 - Remittance Advice (RA) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall promote the use and understanding of the RA as an educational tool for 
communicating claims payment information to providers. 
 
Providers receive an RA, which is a notice of payment and adjustment, once a claim has been 
received and processed.  An adjustment refers to any change that relates to how a claim is paid 
differently from the original billing.  Adjustments can include a denied claim, zero payment, 
partial payment, reduced payment, penalty applied, additional payment and supplemental 
payment.  Two important non-medical code sets are used to communicate an adjustment, or why 
a claim (or service line) was paid differently than the provider billed.  These code sets are Claim 
Adjustment Reason Codes and RA Remark Codes.  Descriptions for both of these code sets 
appear at the official ASC X12 website. 
 
When CMS does not instruct MACs to use specific Claim Adjustment Reason Codes and RA 
Remark Codes to communicate claim payment and adjustment information, and a code would 
help reduce provider inquiries, MACs shall use appropriate codes.  MAC provider inquiry, POE, 
and systems staff shall work together to identify Claim Adjustment Reason Codes and RA 
Remark Codes to help communicate an adjustment and reduce provider inquiries. 
 
MACs shall also promote the use of the free Medicare Remit Easy Print (MREP) software to 
obtain Electronic Remittance Advice (ERA).  (See https://www.cms.gov/Research-Statistics-
Data-and-Systems/CMS-Information-
Technology/AccesstoDataApplication/MedicareRemitEasyPrint.) The benefits of using MREP 
software include saving time and money by printing remittance information directly on the day 
the Health Insurance Portability and Accountability Act (HIPAA) 835 is available without 
waiting for the mail, the ability to create and print special reports, and the ability to create 
document(s) that can be included with claim submissions to secondary/tertiary payers.  The ERA 
is the preferred method for claims payment communication.  When new versions of MREP 
software become available, MACs shall post this notification on their provider education 
websites and communicate this information to their MREP contact list and provider electronic 
mailing list(s). 
 
    If a provider elects to receive the SPR, MACs shall use the SPR provider messaging properties, 
when available, to convey Medicare programmatic information including, but not limited to, the 
promotion of their provider education websites, changes in policies and programs, and the 
promotion of their upcoming POE activities. 
 
20.5 - POE Materials 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall develop clear, concise and accurate POE materials, following the Plain Language 
Act of 2010 guidelines (www.plainlanguage.gov).  MACs shall use CMS-developed materials, 
including MLN products or content, to the extent practicable.  (See section 20.4 of this chapter.)  
MACs shall include production or re-issued month and year for POE materials. MACs shall 
disseminate POE materials timely, efficiently, and cost-effectively.  MACs shall follow IOM 
Pub. 100-04 Claims Processing Manual, Chapter 23 requirements and guidelines for any new or 
revised website and electronic media material. MACs shall make all documents section 508 
compliant. 
 
MACs shall consider all MAC-developed materials the property of CMS, and shall make 
available to CMS upon request. If a MAC reproduces or uses material, in whole or in part, 
originally developed by another MAC, the MAC shall acknowledge the other MAC either within 
the material, or on its cover, case or container. 
 
20.6 - Regular Meetings 
(Rev. 26, Issued: 08-07-09, Effective: 09-01-09, Implementation: 09-08-09) 
 
20.6.1  POE Advisory Groups (POE AGs) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Each MAC shall establish and maintain a POE Advisory Group (POE AG).  The primary 
function of the POE AG is to help the MAC create, implement, and review provider education 
strategies and efforts.  The POE AG provides input and feedback on training topics, provider 
education materials, and dates and locations of provider education workshops and events.  The 
POE AG also identifies salient provider education issues, and recommends effective ways to 
disseminate information to all appropriate providers and their staff.  The POE AG is a provider 
education consultant resource but not an approval or sanctioning authority. 
 
The POE AG should meet three times per year. MACs may hold POE AG meetings in-person or 
via teleconference.  Teleconference/video conference capabilities shall be available for POE AG 
members who cannot be physically present for an in-person POE AG meeting. 
 
The MAC shall maintain the POE AG.  It is not permissible for the MAC to allow outside 
organizations to operate the POE AG.  After soliciting suggestions from the provider 
community, the MAC shall select the appropriate individuals and organizations to be included in 
the POE AG.  The main point of contact for all POE AG communication shall be within the 
MACs POE area.  At a minimum, the MAC is responsible for recruiting potential members, 
arranging all meetings, handling meeting logistics, producing and distributing an agenda, 
    completing and distributing minutes, and keeping adequate records of the POE AGs 
proceedings. 
 
POE AGs operate independently from other existing MAC advisory committees. However, while 
POE AG members can be members of other advisory committees, the majority of POE AG 
members shall not be current members of any other MAC advisory group. MACs shall strive to 
maintain professional and geographic diversity within the POE AG and have representatives of 
the major provider specialties or provider institutions they serve.  Providers from different 
geographic areas, as well as from urban and rural locales, shall be represented in the POE AG. 
 
A MAC shall consider having more than one POE AG when the breadth of its geographic service 
area, or range of the providers serviced, diminishes the practicality and effectiveness of having a 
single POE AG.  Each MAC shall have at least one separate group for each of its contracts (that 
is, at least one POE AG for each MAC jurisdiction).  In addition, a MAC may choose to have a 
single POE AG for all contracts the MAC oversees. 
 
A MAC shall not reimburse or charge a fee to POE AG members for membership or for costs 
associated with serving on the POE AG.  A MAC shall have a specific area on its provider 
education website that allows providers to access information about the POE AG.  This 
information shall include, at a minimum, minutes from meetings, upcoming meeting dates and 
locations, list of organizations or entities comprising the POE AG, and an email address for a 
contact point for further information on the POE AG. 
 
A MAC shall consider the suggestions and recommendations of its POE AG and implement 
those deemed feasible, practicable, and in the best interest of an effective PCSP. In the interest of 
maintaining a working relationship, the MAC shall explain to the POE AG reasons for not 
implementing or adopting any POE AG suggestions or recommendations. 
 
MACs shall distribute meeting times and agendas, which include discussion topics garnered 
from solicitation of POE AG members, to all members of the POE AG and to CMS Central and 
Regional Office staff prior to any meeting.  MACs shall post the POE AG meeting minutes on 
their provider education website within 30 business days after the meeting. 
 
20.6.2  "Ask-the-Contractor Teleconferences (ACTs) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Ask-the-Contractor Teleconferences (ACTs) provides a way for providers to ask their MAC 
specific questions about Medicare billing, policies, or procedures.  MACs can share information 
and listen to their provider community through ACTs. 
 
MACs shall organize toll-free ACTs to complement, but not replace, the work of the POE AG.  
(See section 20.6.1 of this chapter).  MACs shall offer ACTs at least quarterly.   In designing 
ACTs, MACs shall consider other technological approaches, such as web-chat capabilities. 
MACs shall also invite CMS Central and Regional Office staff to listen to ACTs.  MACs shall 
post a complete question-and-answer document on their provider education website within 30 
business days after each ACT.  The question-and-answer document shall include all the 
    questions asked and answered during the ACT, as well as any information presented not part of a 
question or answer.  If no answer could be provided at the ACT for a question asked at the ACT, 
the question-and-answer document shall include that question and its answer.  It is not acceptable 
for MACs to simply post the audio recording of the ACT if there were questions asked during 
the ACT that could not be answered during the ACT. 
 
MACs shall use their POE AG to assist with the timing, frequency, size, topics, and provider 
type(s) included in ACTs.  MACs shall also use other methods for ACT topic identification, such 
as inquiry analysis, claims submission error analysis, MR data analysis, input from PCC staff, 
and information gathered through partnerships. 
  
20.7 - POE Reporting 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall report POE activities in PCID in accordance with section 80.2.3.3 of this chapter. 
 
MACs shall prepare and submit the PCSP documents described in sections 20.7.1 and 20.7.2 of 
this chapter and submit updates as necessary. 
 
Additional reporting may be required.  (See section 20.7.3 of this chapter.) 
 
20.7.1 - Provider Service Plan (PSP) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Each MAC shall prepare and submit to CMS a one-time PSP that outlines the strategies, 
projected activities, efforts, and approaches the MAC will use throughout the duration of its 
contract to support provider education and communications.  The PSP shall address and support 
all the implementation strategies and activities stated in this chapter, as well as all required 
activities stated in the MACs SOW.  An HH+H MAC shall prepare a separate PSP for its 
corresponding HH+H work. 
 
Each MAC shall send the PSP electronically in MS Word to the Provider Services mailbox at 
providerservices@cms.hhs.gov, and to the appropriate Contracting Officer Representative 
(COR) or designee, according to the following schedule:  If the implementation start date is 
between the 1st and the 14th of the month, the PSP shall be due by close of business the last day 
of the month following the start of the implementation period.  If the implementation start date is 
between the 15th and the last day of the month, the PSP shall be due by close of business the last 
day of the second month following the start of the implementation period.  If the due date falls 
on a weekend or holiday, the PSP is due by close of business on the next business day.  The PSP 
is required for each new MAC contract, even if the incumbent is awarded the new contract. 
 
MACs shall use the PSP template/format and instructions located on the CMS website at 
https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/Downloads/PSP-
Template-2015.pdf. MACs shall ensure they are using the most recent version of the PSP 
template/format.  MACs shall be notified of updated templates via the CMS PCUG electronic 
mailing list described in section10.1 of this chapter. 
    20.7.2  Provider Customer Service Program Activity Report (PAR) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Each MAC shall prepare an annual PAR.  The PAR summarizes and recounts the MACs 
provider education and training activities. It shall include a synopsis of activities that took place 
throughout the year and detail activities for the year to come. These activities include efforts to 
reduce the error rate, training events, web efforts, provider education conferences and 
teleconferences, inquiry analyses and follow-up actions, materials development and 
dissemination, and ACT and POE AG meetings.   The PAR must also report any changes to 
information contained in the PSP.  HH+H MACs shall prepare separate PARs for their 
corresponding HH+H work.  MACs are not required to include a listing of POE events because 
that information shall be reported to PCID in accordance with section 80.2.3.3 of this chapter. 
 
The PAR is due to CMS on the 30th calendar day after the last day of the contract year.  If the 
30th calendar day falls on a weekend or holiday, the report is due by close of business on the next 
business day.  MACs shall send all PARs electronically in MS Word to the Provider Services 
mailbox at providerservices@cms.hhs.gov and to the appropriate COR or designee. 
 
MACs shall use the PAR template/format and instructions located on the CMS website at 
https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/Contractor-
Resources.html. MACs shall ensure they are using the most recent version of the PAR 
template/format.  MACs shall be notified of updated templates via the CMS PCUG electronic 
mailing list described in section 10.1 of this chapter. 
 
20.7.3  Discretionary Reporting 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS emphasizes the importance of integration of data analysis across all business functions 
within the MAC, as the MAC continuously assesses the effect of its outreach and education 
efforts upon the error rate. MACs shall work to maintain or improve their CERT scores.  At its 
discretion, CMS may require MACs who do not maintain or improve their scores from their prior 
year scores to submit additional reporting related to the way they use outreach and education to 
achieve a reduction. 
 
20.8 - Charging Fees to Providers for Medicare Education and Training 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS expects that MACs shall not charge for the development, reproduction, or presentation of 
provider education and training materials. 
 
However, there are some circumstances under which MACs may charge fair and reasonable 
fees to offset or recover costs associated with education and training. 
 
This section is not applicable to POE AG meetings/conference calls or ACTs. 
 
 
    20.8.1  No Charge 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall not charge providers who are attending or participating in an education or training 
activity (that is, a non-conference outreach program) based upon a MR identified need for 
education.  (See sections 20.3.6 and 20.4.5.2 of this chapter.) 
 
20.8.2  Fair and Reasonable Fees 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs may charge fair and reasonable Fees to cover the cost of certain POE materials and 
activities.  Fair and reasonable means the fee charged is in line with the actual cost to the MAC 
and is within the means of likely participants in the activity or recipients of materials. 
 
MACs may not use fees to supplement MAC activities in other functional areas. 
 
20.8.2.1  Fees for Materials Available on MACs Provider Education 
Websites 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
MACs may charge a fair and reasonable fee for duplication, shipping, and handling of materials 
available on their provider education website (including duplication in paper or in other formats, 
such as CD-ROM) that they send directly to providers. 
 
20.8.2.2  Fees for Education and Training Activities 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs may charge fair and reasonable fees for education and training activities when those fees 
will be used to offset or recover the costs associated with the following:  travel, facility rental 
and set-up (see section 20.8.3 of this chapter for additional information), equipment rental and 
set-up, and development and reproduction of materials expressly developed for, and 
disseminated at, an education or training activity. 
 
MACs may not use fees to supplement MAC activities in other functional areas. 
 
20.8.2.3  Fees for Videotapes or Recordings of Education and Training 
Activities 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Entities not employed by CMS or not under contractual arrangement with CMS are not permitted 
to videotape or otherwise record education and training activities for profit-making purposes 
unless prior approval is received from the COR.  If a MAC records an education or training 
activity, then the MAC may charge a fair and reasonable fee to duplicate and mail the recording 
to providers upon request. 
 
    20.8.3  Prohibitions 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall not offer providers light food or refreshments at an education or training activity 
unless light food or refreshments are part of the facility rental.  If they are part of the facility 
rental, MACs shall not include the costs of those items in any fees they may charge providers for 
the education or training activity.  MACs shall not advertise the availability of light food or 
refreshments. 
 
MACs may request COR approval if/when there is an education or training event they wish to 
invite CMS employees to participate in or attend. 
 
20.8.4  Reimbursement from Providers for POE Staff Attendance at 
Provider Meetings 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
There may be times when providers or provider societies/associations offer to pay the travel 
costs for a MACs POE staff so this staff can attend and participate in provider meetings.  In 
most instances, MAC staff may accept the travel reimbursement if the event is sponsored by a 
provider society/association.  However, if the event is sponsored by a single provider, the MAC 
shall not accept travel reimbursement. 
 
If a MAC would like to accept the offer of a society or an association, the MAC shall send its 
Contracting Officer Representative (COR) and Contract Specialist a copy of the event invitation 
letter, proposed agenda, and, as applicable, issues upon which the MACs staff is to give a 
presentation or discuss as part of a panel or general question/answer discussion. 
 
In all cases, MACs shall not accept speakers fees, but they may accept small gifts such as pens 
engraved with the host logo, coffee mugs, plaques, flowers, etc.  MACs are not permitted to 
accept or use substantive gifts or donations associated with participation in education and 
training activities absent specific authority from CMS. 
 
20.8.5  Excess Revenues from Provider Participant Fees 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Excess revenues from participant fees may occur when the total of the fees collected exceeds the 
total of the allowable costs. MACs may use one of the following methodologies to determine 
how to handle any excess revenues collected from fee-associated provider education and training 
activities: 
 
Per activity: The total fees collected for any education or training activity should not exceed the 
actual costs incurred for the activity by more than 10 percent.  If the total collected is less than 10 
percent, the MAC may incorporate the excess revenue into its POE program. If the total 
collected exceeds 10 percent, the MAC shall evenly refund the entire excess amount collected to 
all registrants who paid a fee for attending the activity.  For example, the MAC charged 250 
participants a $50 registration fee for an activity that cost the MAC $10,000 (for meeting facility, 
    equipment rental).  Therefore, the MAC collects $12,500.  Since the amount collected exceeds 
the cost of the activity by more than 10 percent, the entire excess amount collected ($2,500) shall 
be equally disbursed back to all paying registrants. 
 
Per year: At the end of the 9th month of the contract year, the MAC shall total the fees collected 
to attend completed fee-associated provider education and training activities for that year.  To 
that amount, the MAC shall add the estimated fees the MAC anticipates collecting from all 
remaining scheduled fee-associated education and training activities.  The MAC shall subtract 
from this amount the total actual and anticipated costs for all past and future fee-associated 
education and training activities for the contract year.  The total remaining should not exceed the 
actual and expected costs incurred for the year by more than 25 percent.  If the amount collected 
is 25 percent or less of total costs, the MAC shall note that amount in its PAR, and incorporate 
the excess revenue into its POE program.  If the amount collected exceeds 25 percent of the total 
costs, the MAC shall send a message by the end of the 10th month of its contract year to the 
Service Reports mailbox at servicereports@cms.hhs.gov listing the amount of excess revenue 
collected and the MACs plan to equally refund the entire excess revenue to all provider 
registrants who attended any of the MACs fee-based education or training activities. 
 
20.8.6  Refunds/Credits for Cancellation of Education and Training 
Activities 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall develop and implement a refund policy and apply it to any education or training 
activity for which they charge a fee.  MACs shall ensure that providers who register for 
education or training activities are aware of the refund policy by including the policy or a 
reference to it on education and training activity registration material or advertising. 
 
CMS understands that, in order to secure accommodations and services for planned provider 
education and training activities, the MAC may have to make commitments under which it will 
incur contractual expenses.  MACs may take this into consideration when determining their 
refund/credit policy.  The policy must, at a minimum, adhere to the following guidelines: 
 
  MACs shall make full or partial refunds/credits to providers who pay a fee to attend an 
activity but who cancel before the activity date.  
 
  MACs shall make full refunds if MACs cancel activities for which provider registrants 
paid fees. 
 
20.8.7  Considerations and Recordkeeping for Fee Collection 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
For each contract year, MACs shall keep records of the actual costs incurred for each education 
or training activity held.  Where applicable, these records shall contain information on the actual 
costs related to the following:  travel, facility rental and set-up, equipment rental and set-up, and 
development and reproduction of materials expressly developed for, and disseminated at, an 
education or training activity.  In addition, MACs shall keep records of all fees charged to, and 
    collected from, provider registrants.  MACs shall keep these records for at least 1 year from the 
date of the education or training activity and shall document actual costs used to support the fees 
charged. 
 
30 - Provider Contact Center (PCC) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS strives to continuously improve Medicare customer satisfaction through the delivery of 
high quality and cost-effective customer service.  High quality customer service is accurate, 
convenient and accessible, courteous and professional, and responsive to the needs of diverse 
groups.  It is important all communication be coordinated to ensure consistent responses due to 
the various communication channels available to providers.  MACs shall develop a PCC offering 
a range of Medicare expertise to respond to telephone, written and walk-in inquiries.  The PCC 
assures a positive business relationship with Medicare providers through its responsiveness to 
providers verbal and written inquiries.  The PCC includes the provider telephone inquiries staff, 
the general written inquiries staff, the Provider Relations Research Specialists (PRRS) (in a joint 
effort with the POE unit), and walk-in inquiries staff. 
 
With the exception of technologies discussed in sections 30.4.2 and 50 of this chapter and in 
chapter 2 of this manual, CMS does not require the use of any specific technologies, as long as 
the MAC is able to meet all performance standards and requirements in a cost-effective and 
efficient manner while providing a high level of quality customer service to providers that 
includes accurate and timely information. MACs shall ensure, at a minimum, PCC staff have 
readily-accessible information and tools (that is, access to claims-related information, access to 
and training on the MACs and CMSs websites, a computer, and an outbound telephone line) so 
that inquiries receive accurate and timely handling. 
 
MACs shall identify at least two points of contact for each PCC. The contacts should have 
knowledge of provider telephone and written inquiries. MACs shall enter each contacts name, 
business telephone number, business email address and point of contact type (telephone, written, 
technical, etc.) in PCID.  See section 80.2.2 of this chapter for PCID reporting and data 
certification requirements. 
 
It is important MACs inform CMS about negative effects on MACs PCCs. CMS monitors PCC 
performance on a daily basis and various factors, such as staffing changes or implementation of 
CRs, could negatively affect PCC performance and produce changes in PCC performance 
statistics.  CMS detects the changes in the performance statistics but may not know the reason(s) 
for those changes, with the exception of reported telecommunications issues, until later
possibly even months later.  To ensure CMS has immediate knowledge of factors impacting the 
performance of the PCCs, MACs shall send an email to the Service Reports mailbox at 
servicereports@cms.hhs.gov with the subject Contractor Alert as soon as they know about 
adverse affects to PCC performance.  The email shall describe the change or event, explain the 
impact on the PCC and, describe what is needed, internally or from CMS, to resolve the matter.  
Changes or events that may produce adverse effects on PCCs include, but are not limited to, the 
following: 
 
      Staffing changes including if staff from other areas help out in the PCC (due to increased 
staff absences or demand) 
 
  Unexpected increase in call volume or written correspondence due to, but not limited to, 
the following:  implementation of a CR or other Medicare policy change, release of a 
new or changed CMS initiative, shared systems issues, non-function or dysfunction of a 
MAC self-service application/tool, other MAC functional department issues, 
unavailability of data from any source used by the PCC, and a national or local 
emergency. 
 
  Abnormal or unexpected changes in CSR availability (for example absences due to 
illness or due to participation in fire drills or other emergency or safety exercises or 
procedures, severe weather, or urgent training) 
 
Reporting a Contractor Alert does not eliminate the requirements to report (1) problems that 
impact the ability to provide telephone service to the providers (section 30.4.4 of this chapter), 
(2) a call completion rate on the CSR-only, IVR-only, or IVR/CSR combined line(s) less than 
the applicable quarterly standard for the previous business day (section 70.2.1 of this chapter), 
(3) an average speed of answer (ASA) on the PCC line(s) higher than the applicable quarterly 
standard for the previous business day (section 70.2.3 of this chapter), (4) monthly reports to 
PCID of telecommunications service interruptions (section 80.2.3.7 of this chapter), or (5) 
monthly reports to PCID of unexpected portal service interruptions (section 80.2.3.8 of this 
chapter). 
 
30.1  PCC Closures 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall report to CMS planned and unplanned closures of the PCC. 
 
30.1.1 - Pre-Approved PCC Closures 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS allows MACs to close their PCCs on the following days without requesting approval:   
 
  New Years Day 
  Martin Luther King, Jr. Day 
  Presidents Day 
  Good Friday 
  Memorial Day 
  Independence Day 
  Labor Day 
  Columbus Day 
  Veterans Day 
  Thanksgiving Day 
  Day After Thanksgiving 
      Christmas Eve 
  Christmas Day 
  Day After Christmas 
 
Although MACs do not need to request CMS approval to close their PCCs on the days listed 
above, MACs shall notify CMS through PCID within 30 calendar days of the start of each 
contract year of PCC closures on any of the days listed above, as well as any other days the 
MAC plans to close the PCC (for example, MAC holidays, corporate meetings, MAC contract or 
systems transitions).  In addition, MACs shall report if they plan to conduct PCC training on any 
of the days listed above in which the MAC has indicated its PCC would be closed. 
 
See section 80.2.2 of this chapter for the PCID reporting requirements. 
 
30.1.2  Planned PCC Training Closures not Pre-Approved PCC Closures 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall request permission to close one or more locations of a jurisdictions PCC for PCC 
training on days other than those referenced in section 30.2.7.1 of this chapter by reporting these 
planned PCC closures in PCID on a monthly basis.  MACs shall consider these PCC closures 
approved unless they hear otherwise from CMS within 5 business days after the PCID reporting 
deadline. 
 
See section 80.2.3.2 of this chapter for the monthly PCID reporting requirements. 
 
30.1.3  Emergency and Similar PCC Closures 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
There may be occasions when a MAC finds it necessary to close one and/or all locations of a 
jurisdictions PCC because circumstances create sufficiently adverse working conditions at a 
PCC location(s) (examples include lack of heat, air conditioning, or water and emergency 
evacuation for health, safety or security reasons) or because a MAC plans a drill or exercise for 
emergency or security preparedness, such as fire and other safety drills, even though such a 
closure may be only for a brief period of time. A MAC shall report each of these PCC closures 
even if the MAC has a plan in place for alternate call handling, as there is no guarantee that, even 
with a plan, calls or call volume would not be adversely affected by the closure.  MACs shall 
report these PCC closures to the Service Reports mailbox at servicereports@cms.hhs.gov within 
1 hour of the decision to close the PCC if the decision to close was made during normal business 
hours, or by 9:00 a.m. Eastern Time the next business day if the decision was made after 
business hours the night before or before business hours that day.  The email shall explain the 
reason for the PCC closure and, if known at the time, indicate when the PCC will reopen. 
 
See section 80.2.3.6 of this chapter for the monthly PCID reporting requirements. 
 
 
 
    30.2 - CSR Equipment Requirements 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
To ensure inquiries receive accurate and timely handling, MACs shall provide each CSR with 
the following: 
 
  Online access to a computer terminal for each CSR who requires online access to answer 
providers questions (the computer terminal shall be physically located so that the CSR 
can research data without leaving his or her desk/seat). 
 
  Access to the MACs provider education website. 
 
  Access to CMSs website. 
 
  An outgoing line for callbacks. 
 
30.3  Inquiry Triage Process 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Provider inquiries may require varying degrees of expertise to answer. Using a triage 
mechanism, the PCC shall be able to route general inquiries within the PCC to the system or 
person best equipped to respond with a minimal degree of transfer. The triage procedures shall 
be used for telephone inquiries, but a MAC may choose to employ a similar mechanism to triage 
general written inquiries as well.  MACs shall develop mechanisms to quickly identify complex 
written inquiries needing referral to the PRRS.  Figure 1 illustrates the levels of complexity and 
the corresponding provider inquiry volume. 
 
Each MAC shall organize its dedicated provider telephone CSRs into at least two levels to 
handle questions of varying complexity. A MAC may also choose to specialize its telephone CSRs 
within levels or across PCC call center locations (if a MAC has more than one call center 
location) to take full advantage of skills-based routing. A MAC may use technology to route 
callers to the appropriate level of telephone CSR. 
 
First-level telephone CSRs shall answer a wide range of basic questions that cannot be answered 
by the IVR system or other interactive self-service technology. At a minimum, these telephone 
CSRs shall handle questions that do not require substantial research and can easily be answered 
during the initial call; however, MACs may choose to have first-level telephone CSRs also 
handle more complex inquiries.  In the event a first-level telephone CSR cannot answer an 
inquiry, the first-level telephone CSR shall have the authority to refer more complex questions to 
second-level telephone CSRs. 
 
Second-level CSRs shall have more experience and expertise, enabling them to answer more 
complex questions, including telephone inquiries requiring a higher level of research.  MACs 
may organize these CSRs in any configuration that best suits the nature of the inquiries received. 
They may serve as consultant subject matter experts for first-level CSRs and, therefore, do not 
always have to speak directly to a provider. These CSRs may be used to answer first-level CSR 
    questions, if the workload demands, and may also handle callbacks.  The most complex questions 
shall be referred to the PRRS, discussed in section 30.7 of this chapter. 
 
For workload reporting purposes, if a call is transferred between telephone CSR levels, the 
inquiry shall remain open until it is fully resolved and shall only be counted once. 
 
Figure 1 
 
 
 
 
30.3.1 - Responding to Coding Questions 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Providers are responsible for determining the correct diagnostic and procedural coding for the 
services they furnish to Medicare beneficiaries.  CSRs shall not make determinations about the 
proper use of codes for the provider.  When providers inquire about interpretation of procedural 
and diagnostic coding, they shall be referred to the entities responsible for those coding sets.  
CSRs shall refer providers with questions about coding to the following information sources, as 
appropriate: 
 
1. Current Procedural Terminology (CPT)1 codes are proprietary to the American Medical 
Association (AMA).  As such, CPT coding questions from providers (with exception 
noted in 4 below) shall be referred to the AMA.  The AMA offers CPT Information 
Services (CPT-IS).  This Web-based service is a benefit to AMA members and is 
available as a subscription fee-based service for non-members and non-physicians.  The 
AMA also offers CPT Assistant. Information about these resources is found at 
https://www.ama-assn.org/.  
 
2. The American Hospital Association (AHA) has a website with many resources for 
answers to coding questions.  Information is available at http://www.ahacentraloffice.org. 
                                                 
1 CPT only copyright 2015 American Medical Association.  All rights reserved. 
    The website also has a direct link to the AHA Coding Clinic 
(http://www.codingclinicadvisor.com) whereby coding questions may be submitted and 
tracked. 
 
3. Level II Healthcare Common Procedure Coding System (HCPCS) codes related to 
durable medical equipment or prosthetics, orthotics, and supplies are answered by the 
Pricing, Data Analysis and Coding (PDAC) Contractor.  Information about the PDAC 
Contractor and the services it provides can be found at https://www.dmepdac.com.  
 
4. Additional information can be found about these resources at: 
http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html.  
 
30.3.8.1  Written Responses to Provider Inquiries -- Quality Written 
Correspondence Monitoring (QWCM) Program Minimum Requirements 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
The MACs written response quality monitoring program shall, at a minimum, follow the 
requirements and performance standards as set forth in the Quality Written Correspondence 
Monitoring (QWCM) program.  Copies of the official QWCM scorecards, Scoring Charts, 
Handbook, and User Guide can be obtained through the QWCM database website at 
https://www.qwcmscores.com/.  A detailed description of each evaluation criterion can be found 
on the official QWCM Scoring Charts and Handbook.  In addition, a MACs provider written 
inquiries monitoring program shall ensure that: 
 
1.  All correspondents responding to provider general, provider PRRS or provider 
Congressional written inquiries are monitored throughout the month.  This includes 
written responses prepared by temporary employees and part-time employees. 
 
2.  Each PCC shall monitor five written responses per correspondent per month per 
jurisdiction. 
 
3.  Responses monitored are those prepared for providers and of the type that the 
correspondent typically handles (general, PRRS, Congressional.) 
 
4.  Responses monitored are sampled randomly so as to be representative of varying days 
of the week, weeks of the month, and monitors/auditors. 
 
5.  Monitoring is done using the official QWCM scorecards and Scoring Charts and 
recorded in the QWCM database.   
 
6.  All responses are evaluated and scores are entered into the QWCM database by the 
10th day of the following month.  For example, responses scored in December shall be 
entered into the QWCM database by January 10.  
 
    7.  Correspondent trainees and new correspondents are adequately monitored.  However, 
scores for correspondent trainees will be excluded from QWCM performance for one 
30-calendar-day period following the end of their formal classroom training. 
 
8.  Monitoring is done in a way that is conducive to the success of the monitoring program.  
 
9.  Timely feedback is provided to correspondents. 
 
10.  PCC staff is properly educated about the program and its use. 
 
11.  All correspondents, reviewers, and supervisors have copies of the official QWCM 
scorecards, Scoring Charts, Handbook, and Writing Guide. 
 
12.  The QWCM Handbook and User Guide are followed. 
 
30.3.8.2  QWCM Calibration 
(Rev.36, Issued: 07-21-17, Effective: 08-22-17, Implementation: 08-22-17) 
 
Calibration is a process to help maintain fairness, objectivity and consistency in scoring written 
responses to provider inquiries that are prepared by staff within one or more PCCs. 
 
MACs shall participate in all national QWCM calibration sessions when organized by CMS.  If 
sessions are organized by CMS, CMS will send appointments to all PCCs via the PCUG 
electronic mailing list.  (See section 10.1 of this chapter.) 
 
When requested by CMS, on a quarterly basis, MACs shall submit to CMS five written provider 
inquiry cases for each line of business in their jurisdictionA/B, HH+H, or DME.  Cases shall 
be submitted by the following dates: 
 
  March 1. 
  June 1. 
  September 1. 
  December 1. 
 
If these dates fall on a weekend or holiday, the MAC shall submit the calls on the next business 
day. The cases shall be actual provider written inquiries responded to within the prior MAC 
contract quarter.  In addition, all cases must have been scored using the QWCM tool and entered 
into the QWCM database.  Each case shall contain the incoming inquiry, response, screenshots 
showing any associated research done in order to supply the response, and a copy of the QWCM 
scorecard.  The CMS shall issue a TDL when requesting MACs to submit cases for written 
inquiry calibration.  The TDL will provide instructions to the MACs on how to format and 
submit the cases. 
 
MACs shall conduct monthly internal calibration sessions.  MACs with reviewers at more than 
one location shall have all the reviewers participate in the monthly calibration sessions.  PCCs 
    shall keep written records of their internal calibration sessions, which shall include attendance 
lists.  These records shall be provided to CMS upon request. 
 
 
 
 
30.3.9 - Replying to Correspondence from Members of Congress 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
In addition to the guidelines outlined above, MACs shall follow the following instructions when 
preparing replies to correspondence from Members of Congress: 
 
A  Sending the Response 
Generally, the MAC sends the original and the courtesy copy of the reply to the Washington, 
D.C. office of the Member of Congress. However, if it is clear that the inquiry was sent from a 
home office, the MAC directs the original and the courtesy copy there. 
 
B - Replying to a Letter Signed by More Than One Member of Congress 
When replying to a letter signed by more than one Member of Congress, the MAC prepares a 
reply for each Member and encloses a courtesy copy with each. The MAC releases the replies to 
each Member of Congress at the same time. 
 
The MAC states in the opening paragraph that the same reply is being sent to each person who 
signed the letter and makes an official file copy for each Member of Congress. The MAC may 
use the following in its final reply: 
 
Similar information is being sent to (Senator or Representative) (name of Member of Congress) 
who also inquired on behalf of (name of provider or beneficiary). 
 
C - Replying to a Letter Signed by an Employee in a Congressional Office 
The MAC addresses replies to the Members of Congress even when the inquiries are signed by 
staff members.  
 
D - Replying Directly to a Constituent at the Request of a Member of Congress 
When addressing a reply to a constituent, the MAC sends a courtesy letterhead copy to the 
Member of Congress, along with a copy of the constituents letter. 
 
E - Replying to an Inquiry from Former Members of Congress 
Unless the former Member of Congress requests otherwise, the MAC addresses the reply to the 
constituent. The MAC shall send a courtesy copy to the former Member of Congress. 
 
F  Addressing the response 
 
The Honorable (full name)   or   The Honorable (full name)  
United States Senate   House of Representatives  
    Washington, D.C. 20510  Washington, D.C. 205l5  
Dear Senator (surname):  Dear Mr./Mrs./Miss/Ms./Dr. (surname): 
   
 
When replying to a home office, address the letter: 
 
The Honorable (full name)                             The Honorable (full name)  
United States Senator   Member, United States House of 
(local address)  Representatives  
Dear Senator (surname):  (local address)  
  Dear Mr./Mrs./Miss/Ms./Dr. (surname): 
   
See the CMS Writing Guide for additional forms of address and salutations. 
 
G - Courtesy Copies 
The MAC prepares a courtesy copy for each congressional response if the congressional office 
has indicated by telephone or letter that it wants one. Document the file if the Member of 
Congress indicates that he/she does not need a copy. 
 
H - Constituents Letter 
Members of Congress frequently forward the constituents letter for assistance in replying. The 
MAC should return the constituents letter, if it is an original, with the first written response.  
When the constituents letter is the only enclosure, on the courtesy copy and all other copies of 
the reply (but NOT ON ORIGINAL), the MAC shall type: 
 
Enclosure: 
Constituents inquiry 
 
When an enclosure in addition to the constituents letter is forwarded to the Member of 
Congress: 
 
  On the original only, at the left margin two lines below the signers title, the MAC shall 
type: Enclosure 
 
  On the copies, beginning at the same place (at the left margin), the MAC shall type:  
Enclosures 2: Including constituents inquiry 
 
30.4 - Provider Telephone Inquiries 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS provides toll-free telephone service to providers using the General Services 
Administrations (GSA) designated contractor for its telecommunications network.  All inbound 
provider telephone service will be handled by the GSAs designated contractor with the 
designated Network Service Provider (NSP).  Therefore, MACs shall not procure or maintain 
    their own local inbound lines. Any new numbers and the associated network circuits used to 
carry these calls shall be acquired via the GSAs designated contractor. 
 
30.4.1  Provider Inquiries Line(s) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
A MACs PCC shall meet standards and requirements, including those related to call handling 
and quality.  When multiple queues come into a MACs PCC (for example, A/B, HH+H, DME, 
appeals, EDI, PE), the statistics for each queue are rolled up into a single set of data that 
determines whether or not the PCC met the standards and requirements.  A queue that fails to 
meet the call handling and quality standards could cause the PCC as a whole to fail to meet those 
standards.  Each MAC has flexibility to configure the PCC in the most effective way to meet the 
standards and requirements of its SOW.  A MAC may have a single toll-free number through 
which providers are routed to the appropriate area, multiple toll-free numbers bringing callers 
directly to each area, or a combination of the two.  CMS encourages MACs to use the fewest 
numbers possible to meet performance standards. 
 
MACs shall report all applicable data (for example, quality call monitoring, telephone inquiry 
tracking, and telephone inquiry reporting) for each queue. 
 
At a minimum, MACs shall use the provider toll-free line(s) to handle questions related to 
billing, claims, eligibility, payment, appeals, EDI, and PE (EDI and enrollment are not applicable 
to DME MACs).  If MACs need new service to handle additional Medicare applications, they 
shall follow the established process for adding additional toll-free numbers.  CMS will consider 
all requests for additional toll-free numbers. 
 
MACs may choose to require callers who do not have provider numbers, such as consultants, 
lawyers and manufacturers, to submit their inquiries in writing. 
 
PCCs may limit the number of inquiries discussed during a single telephone call, but all PCCs 
shall respond to at least three inquiries in a single call before asking the provider to call back. 
 
30.4.1.1  Emergency Toll-Free Line 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall maintain a dedicated toll-free line that can be activated within 48 hours in the event 
of a disaster or national emergency.  MACs who have more than one contract may choose to 
have a line for each jurisdiction or one consolidated line.  
 
The MACs shall configure the lines to handle one or more types of calls and must include audio 
and video recording capabilities. MACs shall retain recordings for a period of at least one year.   
 
30.4.2 - Teletypewriter (TTY) Lines 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
    In accordance with Section 508 of the Rehabilitation Act of 1973 and the Workforce Investment 
Act of 1998, all PCCs shall provide the ability for deaf, hard-of-hearing, or speech-impaired 
providers to communicate via TTY equipment.  A TTY is a special device permitting deaf, hard-
of-hearing, or speech-impaired individuals to use the telephone by allowing them to type 
messages back and forth to one another instead of talking and listening. (A TTY is required at 
both ends of the conversation in order to communicate.)  MACs shall publicize the TTY line on 
their provider education websites.  (This TTY shall also be available for complex beneficiary 
inquiries.) 
 
30.4.3 - Inbound Calls 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
CMS will pay for the rental of inbound lines and all connect time charges for toll-free provider 
services.  CMS will pay for the costs associated with the installation and monthly fees for these 
services and they shall not be considered by MACs in their budget requests.  However, MACs 
shall remain responsible for all other internal telecommunications costs and devices, such as 
agent consoles, handsets, internal wiring and equipment (Automatic Call Distributor (ACD), 
IVR, Private Branch Exchange (PBX), etc.), and any local or outbound telephone services and 
line charges.  Since these costs are not specifically identified in any cost reports, MACs shall 
maintain records for all costs associated with providing telephone service to providers (for 
example, costs for headsets) and shall provide this information upon request by CMS. 
 
30.4.4  Troubleshooting PCC Service Interruptions 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall be responsible for monitoring all aspects of their PCC service operations, including 
the adequacy of their telecommunications operations, and shall take the necessary action to 
quickly diagnose and correct any issues impacting their ability to provide telephone service to 
providers on the IVR-only, CSR-only, and combined IVR/CSR lines, as well as issues that may 
cause interruptions to other PCC services, such as the retrieval of data from back-end systems.  
To monitor and report a problem, MACs shall follow these steps: 
 
1.  Send an email to the Service Reports mailbox at servicereports@cms.hhs.gov with a copy 
to the Provider Network Support (PNS) contractor to notify CMS of a service 
interruption.  The email shall be sent within 1 hour of the start of the service interruption 
if it began during normal business hours, or by 9:00 a.m. ET the next business day if the 
interruption began after business hours the night before or before business hours that day. 
The email shall summarize the problem and the steps taken to restore full service. 
 
  A service interruption is defined as a total loss of service for any length of time or 
any incident lasting at least 30 minutes that impacts the PCCs ability to receive 
calls, answer inquiries, or retrieve data from back-end systems. 
 
  A major service interruption is defined as a total loss of service or any incident 
lasting 2 or more hours and having any of the impacts described above.   
 
    2.  The MAC shall send at least one daily follow-up email to the Service Reports mailbox at 
servicereports@cms.hhs.gov by 12:00 p.m. ET providing a status until the problem has 
been resolved. 
 
3.  Isolate the problem and determine whether the PCC service interruption is caused by:  
 
  Internal customer premise equipment or network service. 
 
  Internal Problem - The MACs local telecommunications personnel shall 
resolve, but report as indicated above. 
 
  External or Network Service Problem  The MAC shall report the problem to 
the toll-free carrier and also report it to CMS as indicated above. 
 
  Some other issue (for example, data is unable to be retrieved from a back-end 
system, such as CWF). 
 
MACs shall involve personnel from the PNS contractor, if needed, to answer technical questions, 
to escalate issues for resolution, or to facilitate discussions with the toll-free carriers Help Desk.  
MACs shall also use the toll-free carriers online system to review documentation and track 
trouble tickets. 
 
 
4.  Within 1 hour after resolution, the MAC shall send an email of resolution to the Service 
Reports mailbox at servicereports@cms.hhs.gov.  
 
See section 80.2.3.7 of this chapter for the monthly PCID reporting requirements related to 
telecommunications service interruptions. 
 
30.4.5 - Requesting Changes to Telephone Configurations 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
The ongoing management of the entire provider toll-free system requires a process for making 
changes, which may be initiated by either the MAC or CMS.  CMS PNS contractor shall 
process all change requests associated with the toll-free network (for example, adding or 
removing channels or T1s, office moves, routing changes).  Any CMS-initiated changes (for 
example, adding lines, removing lines, reconfiguring trunk groups) will be based upon an 
analysis of telephone performance data and traffic reports.  CMS reserves the right to initiate 
changes based on this information. 
 
If a MAC requests a change, it shall send the request and an analysis of its current telephone 
environment (including a detailed traffic report) specific to the service being requested that 
shows the need for changes to the telephone system (for example, additional lines, trunk group 
reconfiguration).  This information shall be sent to the Service Reports mailbox at 
servicereports@cms.hhs.gov. This information shall be gathered through the MACs switch and 
through the toll-free carriers reports.  Based on technical merit and availability of funds, CMS 
    will review the recommendation and make a determination.  In cases where the request is 
approved, CMS will forward the approved requests to the designated agency representative for 
order issuance. 
 
Even if circumstances do not require immediate resolution, MACs shall make requests for 
changes to telephone configurations to CMS in a timely manner.  MACs shall send requests to 
CMS at least 60 calendar days before the requested effective date of the change so all involved 
parties have the opportunity to review the request, ask questions and receive answers, and 
resolve issues. 
 
30.4.6 - Hours of Operation 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall make CSR telephone service available to callers continuously during normal 
business hours, including lunch and breaks. 
 
Normal business hours for live telephone service are 8:00 a.m. through 4:00 p.m. for all time 
zones of the geographical area serviced, Monday through Friday.  Where provider call volume 
supports it, the normal business hours may be shifted for all time zones.  MACs adopting 
alternate hours shall request approval for this alternate schedule by sending an email to the 
Service Reports mailbox at servicereports@cms.hhs.gov within 30 calendar days of the start of 
the contract year, or 1 month in advance of the anticipated change within a contract year. 
 
MACs do not need annual approvals for previously approved alternate schedules if there are no 
additional changes/updates for the hours of operation.  
 
30.4.7 - Providing Busy Signals 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
PCC customer premise equipment shall not be configured/programmed to return soft busies.  
PCCs shall only provide hard busy signals to the toll-free network.  At no time shall any 
software, gate, vector, application, IVR system, or ACD/PBX accept the call by providing 
answer back supervision to the service provided by the GSAs designated contractor and then 
providing a busy signal to the caller and/or dropping the call.  MACs shall optimize their 
inbound toll-free circuits to ensure the proper ratio of circuits to existing full-time equivalent 
(FTE) telephone CSRs. 
 
30.4.8 - Queue Message 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall provide a recorded message that provides the following information while providers 
are waiting in queue to speak to an available telephone CSR: 
 
  Anticipated time until the call will be answered including any temporary delays the 
provider may experience while waiting in queue.  
 
      Non-peak times for providers to call back when the PCC is less busy.  
 
  Information the provider should have available before speaking with a telephone CSR. 
 
  Educational information on issues identified by the MAC.  (See section 20 of this 
chapter). 
 
30.4.9  Provider Telephone Line Staffing 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Provider telephone line(s) staffing, including permanent and temporary staff, shall be based on 
the pattern of incoming calls per hour and day of the week, ensuring adequate coverage of 
incoming calls is maintained throughout each workday for each geographic area serviced within 
a MACs jurisdiction.  In order to provide adequate coverage of incoming calls throughout the 
day, PCCs have the discretion to end a telephone inquiry if the CSR is placed on hold for 2 
minutes or longer.  MACs shall not disconnect a call prior to 2 minutes.  MACs shall, if possible, 
give prior notice to the provider that the CSR may disconnect if the CSR is placed on hold for 2 
minutes and shall politely advise the provider of the best time to call back with all the required 
information at hand. 
 
In circumstances where the PCC is experiencing high call volumes or performance issues, the 
PCC has discretion in allowing CSRs to be placed on hold.  When this happens, CSRs shall 
advise providers that, unfortunately, due to the call volume experienced by the PCC, they are 
unable to be placed on hold.  However, CSRs, at a minimum, shall politely advise providers of 
the best time to call with all the required information at hand.  In consideration of providers, 
when the PCC is contacted with the appropriate information more than once about the same 
transaction, MACs shall exercise discretion in assuring prompt completion of inquiries. 
 
30.4.9.1  CSR Sign-in Policy 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall establish and follow a standard telephone CSR sign-in policy that contains the 
following: 
 
  CSRs available to answer telephone inquiries shall sign in to the telephone system to 
begin data collection. 
 
  CSRs shall sign off the telephone system for breaks, lunch, training, and when 
performing any other non-telephone inquiry workload.  (Note: If the telephone system 
supports an additional CSR category that accumulates this non-telephone inquiry 
performance data so it can be separated and not have any impact on the measurements 
CMS wants to collect, this category may be utilized in lieu of CSRs signing-off the 
system). 
 
  CSRs shall sign off the telephone system at the end of their workday. 
 
    30.4.9.2 - CSR Identification to Callers 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The telephone CSRs shall identify themselves when answering calls.  In order to provide a 
unique identity for each telephone CSR for accountability purposes and to protect the privacy of 
a telephone CSR if an inquiring provider asks the telephone CSR for his/her name, PCC 
management may permit each telephone CSR to use an alias, such as an Operator ID or a 
telephone extension.  This alias shall be known by the MAC and provided to CMS for 
monitoring purposes. 
 
30.4.10 - Monitoring CSR Calls 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
CMS has three monitoring programs to ensure quality responses to calls from providers: (1) 
QCM, (2) QAM, and (3) remote monitoring.  Monitoring the accuracy, completeness, adherence 
to the Privacy Act, and professionalism of telephone CSR-handled calls leads to improved 
customer satisfaction and reduce the number of calls to the PCCs. 
 
As MACs are ultimately responsible for their responses to provider telephone inquiries, MACs 
shall use monitoring results to identify and act upon areas of needed improvement, both for the 
PCC as a whole and for individual telephone CSRs.  MACs shall document the actions, to 
include corrective action plans, as applicable, they take to improve CSR-handled calls if CMS 
monitoring, or their own monitoring, indicates improvements are recommended or required. 
MACs shall provide such information to CMS upon request. 
 
CMS will provide MACs with feedback about monitoring and information about the evaluation 
processes used through the PCUG electronic mailing list and regularly scheduled meetings. 
 
30.4.10.1  Quality Call Monitoring (QCM) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
See section 30.4.12.2 of this chapter for the guidelines and requirements of quality call 
monitoring. 
 
30.4.10.2  Quality Assurance Monitoring (QAM) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall provide the CMS independent monitoring contractor with remote access to their 
quality monitoring systems (such as NICE, QFiniti, and Verint), enabling CMS to conduct more 
comprehensive QAM.  CMS and its independent monitoring contractor will take reasonable 
measures, as necessary and appropriate, to ensure the security of this access.  The secured access 
will provide increased capability to monitor provider calls for accuracy, completeness, adherence 
to the Privacy Act, and professionalism. 
 
    CMS established a Communications Relational Assurance Database (CRAD) at 
https://crad.pccqualitymonitoring.com/login. The CRAD is accessed by CMS and MAC staffs to 
review QAM Scores, Issues, Rebuttals, and Reports. 
 
MACs shall attest at the start of each contract year they are in compliance with CMS 
requirements for QAM as stated in this chapter.  To attest, MACs shall create, sign, scan, and 
save as a .pdf file an Annual MAC QAM Attestation document (see the document requirements 
below).  MACs shall submit the .pdf file as an attachment to an email they shall send to the 
QAM mailbox at QAM@cms.hhs.gov, subject:  Annual MAC QAM Attestation document.  
MACs shall submit their first Annual MAC QAM Attestation document when requested by 
CMS.  Thereafter, MACs shall submit their Annual MAC QAM Attestation document within 15 
business days after the start of each of their contract years. 
 
The Annual MAC QAM Attestation document shall: 
 
  Be prepared on MAC letterhead that includes the MACs business address and clearly 
indicates the applicable MAC jurisdiction. 
 
  Be titled, Annual MAC QAM Attestation for [time period].  For the first Annual MAC 
QAM Attestation document, MACs shall enter, as the time period, the dates specified by 
CMS in CMSs request for the document.  For subsequent Annual MAC QAM 
Attestation documents, MACs shall enter the start and end dates of the applicable 
contract year. 
 
  Include the following statement: This Attestation certifies that MAC Jurisdiction 
[jurisdiction identifier] has a quality monitoring system in place that meets the 
requirements of IOM Pub. 100-09, Chapter 6. 
 
  Be signed and dated by the Manager of the MACs PCC. 
 
In addition to submitting the Annual MAC QAM Attestation document, each MAC shall 
complete the CMS Environment Change Control Form and upload it to the CRAD by the fifth of 
each month to alert the independent monitoring contractor about any hardware and software 
patches/maintenance/upgrades so there are no connectivity issues.  MACs shall select one of the 
following Form Types when uploading the form: 
 
  Planned Change  the MAC plans to change its QAM environment in the upcoming 
month.  Such changes would include the application of hardware, firmware, or software 
patches/maintenance, or upgrades to its QAM environment.  The form shall describe the 
upcoming change(s) and the scheduled implementation date(s) this helps to ensure the 
CMS independent monitoring contractor does not experience QAM quality monitoring 
system issues or problems after the change(s) is implemented.  The CMS QAM 
Environment Change Control Form is available in the CRAD under Forms Upload.  Prior 
to implementing any planned change, the MACs shall conduct all necessary testing of the 
QAM environment to ensure proper and continuous operations of QAM. 
 
      No Planned Changes- the MAC does not plan to make changes for the upcoming 
month; MACs must upload the form to reflect they do not have any planned changes.  
 
  Adverse Event - the MAC experiences an unexpected event that adversely affects, or has 
the potential to adversely affect, QAM.  The form shall include a description of the 
unexpected event, the adverse or the potential adverse effect on QAM, and actions being 
taken to mitigate or eliminate it.  The MAC shall send the form within one hour after they 
detected the adverse event if they detected it during normal business hours, or by 9:00 
a.m. ET the next business day if the adverse event occurred after business hours the night 
before or before business hours that day.  The MAC shall send at least one daily follow-
up to the CRAD providing a status until the adverse effect has been eliminated. 
 
  Emergency Change  the MAC has an emergency and must take immediate action that 
will effect (adverse or otherwise) the QAM environment.  MACs shall upload the form 
within two business days after the emergency situation. 
 
If additional Environment changes occur throughout the month, the MACs shall upload 
additional forms to the CRAD as needed.  This will alert the independent monitoring 
contractor about any monthly hardware and software patches/maintenance/upgrades in order 
to avoid any connectivity issues. 
 
CMS, the Independent Monitoring Contractor, and the MACs work together to complete 
QAM.  MACs shall assist CMS in QAM by completing the following: 
 
  Recording audio and video for at least 30 percent of incoming CSR-handled calls (while 
working in the PCC or remotely) for the line of business of the jurisdiction (A/B, HH+H, 
or DME). 
 
  Establishing current month queries that will provide the CMS independent monitoring 
contractor with access to the audio and video recordings for the appropriate incoming 
CSR-handled calls for the line of business of the jurisdiction (A/B, HH+H, or DME). 
 
  Ensuring the universe of calls available for QAM includes audio and video recordings for 
at least five calls handled by each telephone CSR in the PCC for each jurisdiction per 
month (this may require putting in place special accommodations and processes for QAM 
of remote telephone CSRs) unless circumstances exist that warrant an exception from 
CMS. 
 
  Making available to the CMS independent monitoring contractor the audio and video 
recordings of each call within two business days from the date of the call. 
 
  Retaining audio and video recordings for all calls for a period of 120 calendar days from 
the date of the calls. 
 
      Retaining audio and video recordings for all calls scored for QAM during a contract year 
for a period of 150 calendar days past the contract year end date.  MACs shall identify 
calls scored for QAM by utilizing the Scorecard Report, which is available in the CRAD. 
 
MACs shall follow the requirements in this section and those in the QAM Handbook in 
conducting QAM operations.  The QAM Handbook is available under Resources in the CRAD.  
 
 
 
 
30.4.10.3  Remote Monitoring 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall maintain the ability for CMS to remotely monitor live provider calls in their entirety 
by specific workstation (CSR), next call from the network or next call from the telephone CSR 
queue, or specific business line.  MACs shall make remote monitoring instructions, access codes, 
and telephone CSR IDs available to CMS upon request.  CMS will take reasonable measures to 
ensure the security of this access (for example, passwords will be controlled by one person). 
 
30.4.11  Disaster Recovery Plan 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
When a PCC is faced with a situation that results in a major disruption of service, the PCC shall 
take the necessary action to ensure providers are made aware of the situation.  Whenever 
possible, the PCC is responsible for activating its own emergency messages or re-routing calls.  
However, when this is not possible and providers are unable to reach the PCC switch, the PCC 
shall contact the PNS contractor.  For all other telecommunications support requests, PCCs shall 
follow their normal procedures. 
 
The annual telecommunications Disaster Recovery Plan shall describe how the Medicare 
provider telecommunications operations will be maintained or continued in the event of 
manmade or natural disasters.  The Disaster Recovery Plan shall cover, at a minimum, all items 
outlined in the Disaster Recovery Plan Checklist located at 
https://www.cms.gov/Medicare/Medicare-
Contracting/FFSProvCustSvcGen/Downloads/Disaster-Recovery-Plan-Checklist.pdf.   The 
Disaster Recovery Plan shall also contain a Compliance Matrix that identifies where each item in 
the checklist can be found in the MACs Disaster Recovery Plan.  The Disaster Recovery Plan 
may include arrangements with one or more other MACs to assist in telephone workload 
management during the time the PCC is unable to receive provider telephone calls. 
 
MACs shall submit the Disaster Recovery Plan electronically in MS Word to the Service Reports 
mailbox at servicereports@cms.hhs.gov and to the appropriate Deliverables mailbox by the end 
of the third month of the contract year.  For newly awarded MAC contracts:  If the contract 
award date was between the 1st and the 14th of a month, the initial Disaster Recovery Plan is due 
the last day of the second month that follows the month of the contract award.  If the contract 
award date was between the 15th and the last day of a month, the Disaster Recovery Plan is due 
    the last day of the third month that follows the month of the contract award.  If the due date falls 
on a weekend or holiday, the Disaster Recovery Plan is due by close of business on the next 
business day. 
 
The Disaster Recovery Plan is a separate deliverable, however instead of developing a stand-
alone telecommunications Disaster Recovery Plan, MACs may choose to submit the 
telecommunications portion of their overall MAC contingency plan developed in accordance 
with the requirements found in Pub. 100-17, Centers for Medicare & Medicaid Services (CMS) 
Business Partners Systems Security Manual. 
 
30.4.12 - Guidelines for High Quality Responses to Provider Telephone 
Inquiries 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall monitor, measure, and report the quality of service continuously by employing 
CMSs QCM process.  MACs are encouraged to heavily monitor telephone CSR trainees who 
have just completed classroom instruction before they begin to handle calls without assistance of 
a mentor. 
 
30.4.12.1  Telephone Response Quality Monitoring Program 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall have a monitoring program in place to ensure the quality of telephone inquiry 
responses. The monitoring program is applicable to MACs provider inquiry line(s).   
 
MACs shall use the information from their quality monitoring program to improve telephone 
inquiry responses within the PCC, including individual PCC staff.  MACs shall document their 
monitoring efforts and corrective action plans as applicable and make them available to CMS 
upon request. 
 
30.4.12.2  Telephone Responses to Provider Inquiries -- QCM Program 
Minimum Requirements 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
A MACs monitoring program shall, at a minimum, follow the requirements and performance 
standards as set forth in the QCM program.  MACs shall monitor and report data for all types of 
calls handled by the PCC.  (See section 30.4.12.1 of this chapter.) Copies of the official QCM 
scorecard, User Guide, Handbook, and Scoring Chart can be obtained through the QCM 
database.  A detailed description of the evaluation criteria can be found on the official QCM 
Scoring Chart and Handbook.  In addition, a MACs telephone inquiries monitoring program 
shall ensure: 
 
 
1.  All MAC staff handling provider calls are monitored throughout the month.  This 
includes calls handled by temporary employees, part-time employees, higher-level 
CSRs, and the PRRS. 
     
2.  Each PCC monitors five calls per telephone CSR per month per jurisdiction. 
 
3.  Calls monitored are from providers and are of the type the telephone CSRs level 
typically handles (for example, Level 1, Level 2, PRRS). 
 
4.  Responses monitored are sampled randomly so as to be representative of varying days of 
the week, weeks of the month, and monitors/auditors. 
 
5.  Monitoring is done using the official QCM scorecard and Scoring Chart and recorded in 
the QCM database. 
 
6.  All responses are evaluated and scores are entered into the QCM database by the 10th 
day of the following month.  For example, responses scored in December shall be 
entered into the QCM database by January 10th. 
 
7.  Telephone CSR trainees and new telephone CSRs are adequately monitored.  However, 
scores for telephone CSR trainees will be excluded from QCM performance for one 30-
calendar-day period following the end of their formal classroom training. 
 
8.  Monitoring is done in a way that is conducive to the success of the monitoring program. 
 
9.  Timely feedback is provided to those monitored. 
 
10.  PCC staff is properly educated about the program and its use. 
 
11. All telephone CSRs, Reviewers, and Supervisors have copies of the official QCM 
scorecard, Scoring Chart, and Handbook. 
 
12. The QCM Handbook and User Guide are followed. 
 
30.4.12.3  Recording Calls 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall record incoming CSR-handled calls (while working in the PCC or remotely) as part 
of their contract with CMS to ensure the quality of telephone inquiries.  MACs shall provide 
verbal notification at the beginning of the call announcing that the call may be monitored or 
recorded for training purposes.  If a provider objects to having the conversation recorded, the 
telephone CSR will inform the provider the MAC records calls for the sole purpose of quality 
assurance and training and the recording system cannot be stopped by an individual telephone 
CSR.  If the provider still objects and does not want to continue with the recorded call, the 
telephone CSR will inform the provider that they may send the inquiry in writing.  The telephone 
CSR shall then provide the appropriate address for written correspondence. 
 
When recording for QCM purposes, MACs shall maintain recordings for an ongoing 90-
calendar-day period during the year.  All recordings shall be clearly identified by date and filed 
    in a manner that allows for easy selection for review.  MACs shall dispose of any recordings no 
longer used in a manner that would prohibit someone from obtaining any personally identifiable 
information (PII) or protected health information (PHI) from the recordings. 
 
30.4.12.4  QCM Calibration 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Calibration is a process to help maintain fairness, objectivity and consistency in scoring calls by 
staff within one or more PCCs. 
MACs shall participate in all national QCM calibration sessions when organized by CMS.  
National sessions may be held once per quarter.  If CMS organizes sessions, CMS will send 
appointments to all PCCs via the PCUG electronic mailing list.  (See section10.1 of this chapter.) 
 
When requested by CMS, on a quarterly basis, MACs shall submit to CMS five telephone calls 
for each line of business in their jurisdictionA/B, HH+H, or DME.  Calls shall be submitted by 
the following dates: 
 
  March 1. 
  June 1. 
  September 1. 
  December 1. 
 
If these dates fall on a weekend or holiday, the MAC shall submit the calls on the next business 
day. These calls shall be actual provider inquiries responded to within the prior MAC contract 
quarter.  Rather than looking for perfect calls, CMS would prefer calls that generate discussion 
among the MAC sites. This includes calls where CSRs demonstrate exceptional or unacceptable 
behavior. 
 
All calls submitted for consideration for calibration shall have been scored using the QCM tool 
and entered into the QCM database.  All calls submitted shall have a copy of the QCM scorecard 
attached.  CMS shall issue a Technical Direction Letter (TDL) when requesting MACs to submit 
calls for calibration.  The TDL will provide instructions to the MACs on how to format and 
submit the calls. 
 
MACs shall conduct monthly internal calibration sessions.  MACs with reviewers at more than 
one call center location shall have all their reviewers participate in the monthly calibration 
sessions.  PCCs shall keep written records of their internal calibration. 
 
30.5 - Provider Written Inquiries 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
All provider written inquiries, shall be handled consistently for accuracy, professionalism and 
timeliness.  Every provider written inquiry shall receive a final response that accurately and 
completely addresses the issue(s) contained in the incoming inquiry.  For provider written 
inquiries received that could be handled by the IVR system, such as claim status and eligibility 
inquiries, MACs shall include language in the responses to those inquiries that the information 
    being requested is available on the IVR. (See section 50.1 of this chapter.) MACs also have the 
discretion to encourage providers to use the Web-based provider portal if the functionality exists. 
Additionally, responses should include information about relevant training seminars or 
computer-based training on the MACs provider education website if that is appropriate to the 
topic of the inquiry.  
 
MACs handle the following three types of provider written inquiries: 
 
1. General  provider written inquiries handled within the PCC that do not require extra 
research.  They are subject to the performance standards in this section.  Timeliness 
standards for general provider written inquiries are defined in section 70.3.2.1 of this 
chapter. 
 
2. PRRS  provider written inquiries handled within the PCC that require extra research and 
cannot be handled by the general inquiries staff.  (PRRS inquiries also include all 
beneficiary inquiries referred to the MAC from Call Center Operations (CCO).  See 
chapter 2 of this manual for information about beneficiary written inquiries.)  All PRRS 
provider written inquiries are subject to the performance standards in this section.  
Timeliness standards for PRRS provider written inquiries are defined in section 70.3.2.2 
of this chapter. 
 
3. Congressional  provider written inquiries the MAC receives either directly from a 
Congressional office or from either CMS Central Office or a CMS Regional Office.  
Congressional provider written inquiries are subject to the performance standards in this 
section.  Timeliness standards for Congressional written inquiries are defined in section 
70.3.2.4 of this chapter. 
 
Written responses to provider inquiries shall be prepared in the language of the incoming 
inquiry. 
 
If written responses to provider inquiries contain sensitive or protected information, such as PHI 
or PII, MACs shall apply reasonable safeguards in responding to protect that information from 
inappropriate use or disclosure.  See section 30.5.5 of this chapter regarding specific 
requirements for electronic responses to provider inquiries. 
 
MACs may use the following methods to respond to provider written inquiries regardless of the 
way the inquiry was received: 
 
1.  Postal - hardcopy letters sent through the USPS 
 
2.  Telephone  outbound calls to providers 
 
3.  Electronic  electronic responses sent through email, fax, internet portals or other 
approved electronic mechanisms  
 
30.5.1 - Controlling Provider Written Inquiries 
    (Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall control all provider written inquiries until they are closed by the written inquiry unit.  
Provider written inquiries are closed by the written inquiry unit (1) upon release of the final 
response, (2) upon transfer of the inquiry to another department within the MAC, or (3) upon 
rerouting of the inquiry to the appropriate external entity. 
 
The MAC shall stamp the cover page of all provider written inquiries and the top page of all 
attachments with the date of receipt in the corporate mailroom.  Electronic inquiries that contain 
system-generated date stamps are not required to receive an additional corporate date stamp; 
however, electronic inquiries received after the close of a MACs normal business day shall be 
date-stamped the next business day.  For provider inquiry timeliness purposes, the date of receipt 
shall be counted as day one. 
 
MACs shall not be required to keep the incoming envelope.  However, if it is a MACs normal 
operating procedure to keep envelopes with the incoming correspondence, the envelope, 
incoming correspondence, and the top page of all attachments shall be date-stamped in the 
corporate mailroom. 
 
The corporate mailroom shall forward provider written inquiries, with the exception of misrouted 
provider written inquiries, to the PCCs written inquiry unit where they will be controlled. 
 
The following definitions and handling instructions shall be applied to provider written inquiries 
transferred or misrouted: 
 
  A transferred inquiry is correspondence received in the written inquiry unit that should be 
handled by another department within the MAC.  The written inquiry unit shall transfer it 
to the proper department within the MAC, which closes the inquiry in the written inquiry 
unit.  The written inquiry unit shall report transferred inquiries in Provider Inquiries 
Evaluation System (PIES).  Transferred inquiries are reported in PCID/Inquiry Tracking 
using the appropriate Category or Subcategory. 
 
  A misrouted inquiry is correspondence received either in the corporate mailroom or in the 
written inquiry unit that was not intended for the MAC.  The corporate mailroom or the 
written inquiry unit shall reroute it to the proper external entity which, if the inquiry had 
been received by the written inquiry unit, closes the inquiry in the written inquiry unit.  
The written inquiry unit shall report misrouted inquiries in PIES and in PCID/Inquiry 
Tracking.  In rerouting a misrouted inquiry, MACs shall use one of the options below: 
 
1.  Contact the provider and inform the provider that the correspondence was 
misrouted and is being rerouted to the appropriate external entity; inform the 
provider of the name and mailing address of the appropriate external entity (for 
the providers possible future use); and reroute the correspondence to the 
appropriate external entity. 
 
    2.  Contact the provider and inform the provider that the correspondence was 
misrouted and is being returned to the provider; inform the provider of the name 
and mailing address of the appropriate external entity (so that the provider can 
send it to the appropriate external entity); and return the correspondence to the 
provider. 
 
The above definitions and handling instructions also apply to Congressional provider written 
inquiries.  Be mindful that the timeliness standards for responses to Congressional inquiries are 
more stringent than the standards for other responses. 
 
 30.5.2 - Provider Written Inquiry Storage 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall allow CMS access to all provider written inquiries stored off site within 24 hours of 
notification to the MAC. All provider written inquiries, whether maintained on site or off site, 
shall be clearly identified and filed in a manner that will allow for easy selection for review. 
 
MACs shall enter in PCID the physical address of where they store their provider written 
inquiries.  MACs shall enter changes to this information in PCID within 14 calendar days of the 
change. 
 
See section 80.2.2 of this chapter for the PCID reporting and data certification requirements. 
 
30.5.3  Duplicate Inquiries 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
In cases where a MAC is able to determine a provider sent a duplicate written inquiry to the 
MAC, the MAC may verify, by telephone or letter, the provider received a response to the initial 
inquiry.  If the MAC uses a letter to obtain verification the provider received a response to the 
initial inquiry, the MAC counts that letter as an interim response.  After verification the provider 
received a response to the initial inquiry, the MAC shall close the duplicate inquiry and exclude 
it from workload reporting.  If the provider did not receive a response to the initial inquiry, the 
MAC shall prepare a response to the duplicate inquiry and include it in workload reporting.  If 
the MAC does not receive a response from the provider within 14 business days after attempting 
to verify the receipt of a response to the initial inquiry, the MAC shall prepare a response to the 
duplicate inquiry and include it in workload reporting. 
 
30.5.4 - Telephone Responses to Provider Written Inquiries 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs may respond to general provider and PRRS provider written inquiries by telephone within 
45 business days of receipt of the inquiry.  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, the MAC shall develop a report of contact for each 
telephone response to a provider written inquiry.  The report of contact shall be retained in the 
same manner and time frame as written responses.  All reports of contact shall contain the 
following information: 
 
  Provider name; when applicable, MACs shall also include the Name of the providers 
representative or billing company name that contacted the PCC on the providers behalf. 
  Provider telephone number. 
  Provider number (National Provider Identifier [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. 
 
If the 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.  
MACs may send the information via email or fax, if requested by the provider; if the email or fax 
response would contain any protected or sensitive information, such as PII or PHI, MACs shall 
follow the requirements of section 30.5.5 of this chapter.  It is not acceptable to send the report 
of contact itself.  All timeliness and quality guidelines for a written response apply to the 
response sent. 
 
If the MAC cannot reach the provider by telephone, the MAC shall develop a written response 
within 45 business days of receipt of the incoming inquiry.  It is not acceptable to leave a 
message/response on the providers voicemail. 
 
30.5.5  Electronic Responses to Provider Written Inquiries 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
In some cases, provider written inquiries can be responded to by email, fax, provider internet 
portal or through other approved electronic mechanisms.  Since all represent official 
correspondence with the public, it is paramount MACs use sound practices and proper etiquette 
when communicating electronically. MACs shall ensure electronic responses follow the same 
timeliness and quality guidelines that pertain to all provider written inquiries.  MACs shall 
transmit electronic responses that contain protected or sensitive information in accordance with 
the CMS Acceptable Risk Safeguard controls and other CMS directives for secure 
communications.   
 
When responding via fax, MACs shall first confirm the fax number with the intended provider 
recipient.  MACs may pre-program frequently used fax numbers directly in their fax machines to 
avoid misdirecting information. 
 
    Email content, including attachments, must be section 508 compliant.  (See 
https://www.cms.gov/About-CMS/Agency-Information/Aboutwebsite/Policiesforaccessibility 
for information about section 508 compliancy.) 
 
 
 
30.5.6 - Check Off Letters 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Check-off letters are appropriate for responding to routine provider written inquiries like claim 
status or eligibility inquiries.  Check-off letters shall not be used to address more complex 
inquiries.  Each check-off letter shall be personalized and follow the same timeliness and quality 
guidelines that pertain to all written responses to provider inquiries. 
 
30.5.7 - Guidelines for High Quality Responses to Provider Written Inquiries 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs written provider inquiry responses shall be professional accurate, complete, responsive, 
and clearly written.   
 
MACs shall ensure written provider inquiry responses 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, or (3) explains how to comply with federal requirements.  MACs shall refer to the 
document entitled, Toolkit for Making Written Material Clear and Effective to help meet the 
requirements of the Plain Writing Act of 2010.  The Toolkit is a CMS health literary.  It is 
available at https://www.cms.gov/Outreach-and-
Education/Outreach/WrittenMaterialsToolkit/index.html. 
 
In addition, MACs shall use the CMS Writing Guide to help prepare written responses to 
provider inquiries.  The Writing Guide can be found in the Documentation Section of the 
QWCM database.     
 
Because the Toolkit and CMS Writing Guide does not address every issue, MACs may also use 
other resources (for example, grammar guides) to supplement their writing process. 
 
30.5.8  Stock Language/Form Letters 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Periodically, CMS may request MACs submit their most frequently used stock language or form 
letters they send to providers.  CMS will review the stock language or form letters and provide 
suggestions to improve the language.  If CMS determines the stock language or form letters have 
errors or issues affecting the readability or meaning of the response, MACs shall make revisions 
    within 60 business days from the day CMS gave notice.  Please refer to the Toolkit and the CMS 
Writing Guide described in section 30.5.7 of this chapter for additional guidance. 
 
 
 
 
 
30.5.9 - Provider Written Response Quality Monitoring Program 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall maintain a monitoring program for all written provider inquiry responses (general, 
Congressional, and PRRS).   The quality monitoring standards shall not apply to those responses 
to provider written inquiries handled by other departments within the MAC. 
 
MACs shall use information from their quality monitoring program to improve written responses 
within the PCC, including individual PCC staff.  MACs shall document their monitoring efforts 
and corrective action plans, as applicable, and make them available to CMS upon request. 
 
30.5.9.1  Written Responses to Provider Inquiries -- QWCM Program 
Minimum Requirements 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The MACs written response quality monitoring program shall, at a minimum, follow the 
requirements and performance standards as set forth in the QWCM program.  Copies of the 
official QWCM scorecards, Scoring Charts, Handbook, and User Guide can be obtained through 
the QWCM database.  A detailed description of each evaluation criterion can be found on the 
official QWCM Scoring Charts and Handbook.  In addition, a MACs provider written inquiries 
monitoring program shall ensure that: 
 
1. All MAC staff responding to provider general, provider PRRS or provider Congressional 
written inquiries are monitored throughout the month.  This includes written responses 
prepared by temporary employees and part-time employees. 
 
2. Each PCC shall monitor five written responses per written CSR per month per 
jurisdiction. 
 
3. Responses monitored are those prepared for providers and of the type the written CSR 
typically handles (general, PRRS, Congressional.) 
 
4. Responses monitored are sampled randomly so as to be representative of varying days of 
the week, weeks of the month, and monitors/auditors. 
 
5. Monitoring is done using the official QWCM scorecards and Scoring Charts and recorded 
in the QWCM database.   
 
    6. All responses are evaluated and scores are entered into the QWCM database by the 10th 
day of the following month.  For example, responses scored in December shall be 
entered into the QWCM database by January 10.  
 
7. Written CSR trainees and new written CSRs are adequately monitored.  However, scores 
for written CSR trainees will be excluded from QWCM performance for one 30-
calendar-day period following the end of their formal classroom training. 
 
8. Monitoring is done in a way that is conducive to the success of the monitoring program.  
 
9. Timely feedback is provided to those monitored. 
 
10.  PCC staff is properly educated about the program and its use. 
 
11.  All written CSRs, reviewers, and supervisors have copies of the official QWCM 
scorecards, Scoring Charts, Handbook, and Writing Guide. 
 
12.  The QWCM Handbook and User Guide are followed. 
 
30.5.9.2  QWCM Calibration 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Calibration is a process to help maintain fairness, objectivity and consistency in scoring written 
responses to provider inquiries prepared by staff within one or more PCCs. 
 
MACs shall participate in all national QWCM calibration sessions when organized by CMS.  If 
sessions are organized by CMS, CMS will send appointments to all PCCs via the PCUG 
electronic mailing list.  (See section 10.1 of this chapter.) 
 
When requested by CMS, on a quarterly basis, MACs shall submit to CMS five written provider 
inquiry cases for each line of business in their jurisdictionA/B, HH+H, or DME.  Cases shall 
be submitted by the following dates: 
 
  March 1. 
  June 1. 
  September 1. 
  December 1. 
 
If these dates fall on a weekend or holiday, the MAC shall submit the cases on the next business 
day. The cases shall be actual provider written inquiries responded to within the prior MAC 
contract quarter.  In addition, all cases must have been scored using the QWCM tool and entered 
into the QWCM database.  Each case shall contain the incoming inquiry, response, screenshots 
showing any associated research done in order to supply the response, and a copy of the QWCM 
scorecard.  CMS shall issue a TDL when requesting MACs to submit cases for written inquiry 
calibration.  The TDL will provide instructions to the MACs on how to format and submit the 
cases. 
     
MACs shall conduct monthly internal calibration sessions.  MACs with reviewers at more than 
one location shall have all the reviewers participate in the monthly calibration sessions.  PCCs 
shall keep written records of their internal calibration sessions, which shall include attendance 
lists.  These records shall be provided to CMS upon request. 
 
30.5.10 - Replying to Correspondence from Members of Congress 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
In addition to the guidelines outlined above, MACs shall use the following instructions to 
respond to Members of Congress: 
 
A  Sending the Response 
Generally, the MAC sends the original and the courtesy copy of the reply to the Washington, 
D.C. office of the Member of Congress. However, if it is clear that the inquiry was sent from a 
home office, the MAC directs the original and the courtesy copy there. 
 
B - Replying to a Letter Signed by More Than One Member of Congress 
When replying to a letter signed by more than one Member of Congress, the MAC prepares a 
reply for each Member and encloses a courtesy copy with each. The MAC releases the replies to 
each Member of Congress at the same time. 
 
The MAC states in the opening paragraph that the same reply is being sent to each person who 
signed the letter and makes an official file copy for each Member of Congress. The MAC may 
use the following in its final reply: 
 
Similar information is being sent to (Senator or Representative) (name of Member of Congress) 
who also inquired on behalf of (name of provider or beneficiary). 
 
C - Replying to a Letter Signed by an Employee in a Congressional Office 
The MAC addresses replies to the Members of Congress even when the inquiries are signed by 
staff members.  
 
D - Replying Directly to a Constituent at the Request of a Member of Congress 
When addressing a reply to a constituent, the MAC sends a courtesy letterhead copy to the 
Member of Congress, along with a copy of the constituents letter. 
 
E - Replying to an Inquiry from Former Members of Congress 
Unless the former Member of Congress requests otherwise, the MAC addresses the reply to the 
constituent. The MAC shall send a courtesy copy to the former Member of Congress. 
 
F  Addressing the response 
 
The Honorable (full name)   or   The Honorable (full name)  
United States Senate   House of Representatives  
Washington, D.C. 20510  Washington, D.C. 205l5  
    Dear Senator (surname):  Dear Mr./Mrs./Miss/Ms./Dr. (surname): 
   
 
When replying to a home office, address the letter: 
 
The Honorable (full name)                             The Honorable (full name)  
United States Senator   Member, United States House of 
(local address)  Representatives  
Dear Senator (surname):  (local address)  
  Dear Mr./Mrs./Miss/Ms./Dr. (surname): 
   
See the CMS Writing Guide for additional forms of address and salutations. 
 
G - Courtesy Copies 
The MAC prepares a courtesy copy for each congressional response if the congressional office 
indicated by telephone or letter it wants one. If the response contains a social security number 
(SSN), the MAC must redact the SSN in the courtesy copy to the congressional office. 
Document the file if the Member of Congress indicates he/she does not need a copy. 
 
H - Constituents Letter 
Members of Congress frequently forward the constituents letter for assistance in replying. The 
MAC should return the constituents letter, if it is an original, with the first written response 
unless it contains a SSN.   
 
When the constituents letter is the only enclosure, on the courtesy copy and all other copies of 
the reply (but NOT ON ORIGINAL), the MAC shall type: 
 
Enclosure: 
Constituents inquiry 
 
When an enclosure in addition to the constituents letter is forwarded to the Member of 
Congress: 
 
  On the original only, at the left margin two lines below the signers title, the MAC shall 
type: Enclosure 
 
  On the copies, beginning at the same place (at the left margin), the MAC shall type:  
Enclosures 2: Including constituents inquiry. 
 
30.6 - Provider Walk-In Inquiries 
 (Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
In the rare circumstance a provider comes on site to the MAC to make an inquiry, the MAC shall 
address the provider's concern(s) and shall count and report the contact as a provider written 
    inquiry.  The MAC shall maintain a log or record of walk-in inquiries.  The log, at a minimum, 
shall include the following: 
 
  Name of provider. 
  Date and time of arrival. 
  Time service was provided. 
  Name of the person handling the inquiry. 
  A statement indicating the resolution of the inquiry and the date resolved. 
 
30.6.1 - Guidelines for Provider Walk-In Service 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The MAC shall use the following guidelines when providing high quality walk-in service: 
  The provider shall be given the opportunity to meet with a service representative. 
  Waiting room accommodations shall provide seating. 
  Inquiries shall be handled completely during the initial interview to the extent possible. 
  Current Medicare publications shall be available to the provider (upon request). 
  MACs shall maintain a log or record of provider walk-in inquiries handled during the 
year. 
 
30.7 - PRRS Operations 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall maintain PRRS operations as a joint effort between the PCC and POE units to 
provide consistent, accurate, and timely information to Medicare providers regarding complex 
inquiries that cannot be answered by the MACs telephone or written inquiries staff or require 
significant research. Therefore, MACs shall design and staff the PRRS component so questions 
beyond the expertise of the CSRs which require more time to adequately research can be 
answered in a timely and efficient manner.  The PRRS staff shall also identify provider education 
topics based on the complex inquiries received if the MAC determines general provider 
education on these specific topics would be practical and useful to the provider community and 
reduce inquiries.  (The PRRS shall also handle complex beneficiary inquiries that cannot be 
resolved by CCO.) 
 
For workload reporting purposes, upon referral of a provider telephone inquiry to the PRRS, the 
telephone inquiry shall be closed and a written inquiry shall be opened.  A written inquiry that is 
referred to the PRRS shall remain open and only be counted once. 
 
30.7.1 - Complex Provider Inquiries 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
    Once a provider inquiry is referred, the PRRS shall take ownership of the inquiry and research 
and resolve it.  The PRRS staff shall respond to the more complex provider questions including 
those related to coverage policy, coding, and payment policy.  Staff shall use the full spectrum of 
the MACs resources (for example, MAC provider education website, MR staff, MAC medical 
directors, claims processing staff), and CMS resources (for example, Internet-Only Manual, 
MAC instructions, training packages, Medicare laws and regulations, the CMS website, MLN 
products or content, provider-specific web pages, and CMS Regional Office staff) when 
researching answers to complex inquiries. 
 
The PRRS shall include at least one certified coder to ensure adequate coding expertise although 
that staff does not have to be assigned exclusively to the PRRS. DME MACs are exempt from 
the requirement to have a coding expert since the PDAC resolves DME coding questions.  The 
coding questions appropriately answered by the PRRS are those concerning the underlying 
Medicare payment or coverage policy.  Pure coding questions (not related to a Medicare 
payment or coverage policy) shall be answered with referrals to the correct organizations such as 
the American Medical Association and the American Hospital Associations Coding Clinic. For 
more information, see section 30.3.1 of this chapter. 
 
30.7.2 - Complex Beneficiary Inquiries 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Complex beneficiary inquiries will be identified and referred to the PRRS by CCO or the CMS 
Regional Office via the Next Generation Desktop (NGD) and may include, but are not limited to, 
telephone, written, and email inquiries.  See chapter 2 of this manual for information about 
handling, controlling, and responding to beneficiary inquiries. 
 
30.8 - Provider Inquiry Tracking 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS requires MACs to track and report the reason for telephone and written inquiries using 
categories and subcategories found in the CMS Standardized Provider Inquiry Chart.  The chart 
can be found at https://www.cms.gov/Medicare/Medicare-
Contracting/ContractorLearningResources/Downloads/Standardized_Provider_Inquiry_Chart.pd
f. MACs also have the flexibility to add contractor-specific subcategories to track provider 
inquiries that may arise within its jurisdiction (See Section 30.8.D).    
 
Inquiry logging, tracking and reporting applies for all PCC call center locations (i.e., if a MAC 
has multiple call center locations), all PCC triage levels (for example, Level 1, Level 2, PRRS), 
and all provider inquiries handled by the PCC (i.e., general inquiries, escalated inquiries within 
CSR levels, Congressional inquiries), including other inquiries handled within the PCC (for 
example, PE, Appeals, EDI, Adjustment/Reopening, MR, Audits and Reimbursement), and in 
accordance with the MACs SOW.   
 
A.   Inquiry Tracking Requirements 
 
    MACs shall maintain an Inquiry Tracking System for all provider inquiries that identifies at a 
minimum: 
 
1. Type of inquiry (telephone, written, walk-in). 
 
2. Person responsible for answering the provider inquiry  
 
3. Information about the inquirer (name, NPI and PTAN). 
 
4. Nature of the inquiry (according to the categories and subcategories in the CMS 
Standardized Provider Inquiry Chart and contractor-specific subcategories, when 
appropriate).  The nature of the inquiry relates to the reason or the issue that 
caused/originated the provider contact to the PCC. 
 
5. Disposition of the inquiry, including referral to other PCSP areas or areas elsewhere at 
the MAC (for example, MR, MSP) and in the referral information about how to contact 
the provider in case there is a need to clarify the question. 
 
6. Timeliness of the response. 
 
B.   Inquiry Tracking Data Use 
 
MACs shall use inquiry tracking data to enhance and improve their PCSP. Inquiry tracking 
data at the PCSP is/can be used to: 
 
1.  Develop reports (CMS encourages MACs to review inquiry tracking data as often 
as possible to prevent inquiry volume from rising, to identify patterns of 
providers inquiries, and to monitor provider inquiry trends). 
 
2.  Identify areas for broader provider and CSR education. 
 
3.  Conduct analysis of the number and types of inquiries to develop FAQs to be 
posted on the MACs provider education websites. 
 
4.  Assess, evaluate and monitor the effectiveness and efficiency of Medicare and 
MAC internal and external policies, process and procedures. 
 
5.  Assess and document enhancements and innovations to improve the Medicare 
provider customer service experience (for example, provider self-service 
technology, POE website content), effectiveness and efficiency of operations, 
when appropriate. 
 
6.  Assess/estimate PCC staff skill level needs based on the frequency, complexity or 
trends on provider inquiries 
 
    7.  Identify areas or processes within the MACs organization that may need follow-
up (for example, to maintain/reduce provider inquiries, to meet response and/or 
processing targets, to meet POE objectives/targets, to reduce provider burden). 
 
C.  Requirements for Classifying the Nature of Inquiries 
 
MACs shall follow these additional requirements when classifying the nature of the provider 
inquiries received: 
 
1.  Use categories and subcategories in the CMS Standardized Provider Inquiry Chart 
to classify and log all written and telephone inquiries.  MACs develop and 
implement contractor-specific subcategories to capture an additional level of 
detail, if necessary, to support CMS in developing new inquiry types, and to 
identify provider education or CSR training needs.   
 
2.  Use categories and subcategories in the CMS Standardized Provider Inquiry Chart 
to capture the reason/issue for the inquiry, not the status, the disposition (for 
example, Referrals to the IVR), or the action taken. To capture the most relevant 
and accurate inquiry data when logging a provider inquiry in the MAC Inquiry 
Tracking System, all PCC staff shall exercise best judgement in identifying the 
true issue of the provider contact to the PCC.  
 
3.  Track multiple issues raised by a provider during a single call or in a single 
written inquiry, as long as MACs are able to identify the information related to an 
inquiry (See Section 30.8.A) and to comply with the inquiry tracking reporting 
requirements in this chapter.  
 
4.  Report inquiries that do not fall under any of the existing predefined subcategories 
using the Not Classified field for the appropriate category (with the exception 
of the General Information category that uses the Other Issues subcategory 
instead of Not Classified).  However, MACs shall minimize the number of Not 
Classified and Other Issues inquiries by suggesting updates to the CMS 
Standardized Provider Inquiry Chart or by creating contractor-specific 
subcategories (See Section 30.8.D). 
 
D.   Guidance for Creating Contractor-Specific Subcategories 
 
MACs shall adhere to the following requirements when creating contractor-specific 
subcategories: 
 
1.  MACs shall maintain and promote a dynamic process to identify and create 
contractor-specific subcategories that could potentially lead to new or enhanced 
inquiry types when the need arises.  Although no specific target will be 
implemented at this time, MACs shall create contractor-specific subcategories to 
continuously identify and to reduce the number of inquiries that do not fall under 
any of the existing standardized inquiry categories/subcategories CMS will 
    monitor contractor-specific subcategories to assess inquiry trends and determine 
future inquiry developments. 
 
2.  MACs shall not create contractor-specific subcategories when the CMS 
Standardized Provider Inquiry Chart provides existing standard existing 
subcategories that can be used to log and report those inquiries.  Example:  A 
MAC should not create a contractor-specific subcategory called HCPCS under 
the Coding category because the chart already provides Procedure Codes as 
one of the standard subcategories under Coding. 
3.  MACs shall assign a specific descriptive name and a descriptive definition to each 
contractor-specific subcategory they create and report to CMS.  This is essential 
to identify what is being reported.  Do not use Subcategory 1 or Subcategory 
2 or Contractor-Specific as the descriptive names. CMS encourages the MACs 
to consider using the following when creating contractor-specific subcategories: 
 
  Number(s) of an MLN Matters Article that describes the nature of the 
inquiry  
  RARC/CARC code combinations normally included in CRs.  
  Shared Systems/CWF edits codes with their definitions.  
  Specific claim improper payment issues (for example, specific coding 
error, specific missing information to determine medical necessity to 
justify level of service) 
  Specific claim submission errors (for example, specific missing 
documentation, lack of signature) 
 
4.  MACs shall create contractor-specific subcategories for issues that have a 
significant impact on their operations or represent a significant amount of 
inquiries related to a topic. 
 
5.  MACs shall regularly review their contractor-specific subcategories and 
deactivate them when there is low inquiry volume (less than 10 inquiries) for 
three months in a row.  This does not apply to those contractor specific sensitive 
subcategories related to Program Integrity or specific to POE operations. 
 
6.  MACs shall not create contractor-specific subcategories under the Temporary 
Issues category that could be added as contractor-specific subcategories under a 
more related category.  Example:  A MAC should not create a contractor-specific 
subcategory called HMO Refunds under the Temporary Issues category 
because a subcategory of HMO Refunds would more appropriately belong 
under the Financial Information category. 
 
7.  MACs shall not use provider types/specialties as contractor-specific names since 
inquiry tracking reports can be run by provider types/specialties (for example, 
hospitals, home health agencies physicians and cardiology).  However, CMS 
encourages MACs to use a POE training topic as a contractor-specific 
subcategory. 
     
8.  MACs shall add a contractor-specific subcategory as CMS directs.  Although 
CMS does not plan to use this option frequently, CMS may need to immediately 
assess specific provider inquiries.  In this instance, CMS may add a contractor-
specific subcategory in the PCID Contractor-Specific Subcategories Module. 
 
 
 
 
30.8.1  Updates to the CMS Standardized Provider Inquiry Chart 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS will update the chart as needed, including adding subcategories under the Temporary 
Issues category to track inquiries that may be short-lived. Changes to the CMS Standardized 
Provider Inquiry Tracking Chart, including reporting timeframes, will be issued through CRs or 
TDLs.  Upon issuance MACs shall update their MAC Inquiry Tracking Systems with any 
updates or additions (See Section 30.8.A of this chapter).  Between updates, MACs may create 
and add contractor-specific temporary subcategories for their jurisdiction(s) if their call volume 
dictates. Per section 30.8.D of this chapter, CMS may also request MACs to assess 
recommended inquiry types using contractor-specific subcategories. 
 
The latest version of the CMS Standardized Provider Inquiry Tracking Chart is located at 
https://www.cms.gov/Medicare/Medicare-
Contracting/ContractorLearningResources/Downloads/Standardized_Provider_Inquiry_Chart.pd
f. 
 
As necessary, MACs shall recommend changes to the CMS Standardized Provider Inquiry Chart, 
including modifications to existing categories and subcategories and the addition of new inquiry 
categories and subcategories. MACs shall submit changes or comments related to the CMS 
Standardized Provider Inquiry Chart via the Provider Services mailbox at 
providerservices@cms.hhs.gov. Suggested changes shall include the following information:  
 
  Name of the proposed category or subcategory. 
  Definition of the proposed inquiry category or subcategory. 
  Examples of questions received where the proposed inquiry category or subcategory 
could be used.  
  Information about the number of inquiries the MAC received associated with the 
proposed category or subcategory. 
 
30.8.2  MAC Inquiry Tracking Self-Data Review and Self-Validation Process  
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall document inquiry tracking data review activities and validation procedures, 
including major components of the process (for example, analyzing inquiry trends), 
developments and/or enhancements (for example, Inquiry Tracking System, inquiry types, CSR 
    desk procedures to log inquiries, resources to complement inquiry analysis), and identification 
and mitigation for areas vulnerable to errors. 
 
At least monthly, MACs shall analyze their PCSP inquiry data.  MACs shall look at changes in 
the inquiry volume/proportion/trends and by provider specialty.   
 
CMS encourages MACs to explore additional MAC resources to adopt focused, effective, and 
efficient analyses practices.  This may include collaborating with other MACs. 
 
1.  Monitoring of Not Classified Inquiries 
MACs shall regularly analyze the Not Classified subcategories to ensure CSRs 
do not report a high number of similar inquires in these subcategories when the 
MAC should create a contractor-specific subcategory instead.  
 
2.  Provider Inquiry Proportional Changes  
MACs shall monitor their inquiry tracking volume to determine the proportional 
changes over at least the previous month and with the same period last year to identify 
the following:  
 
  Whether inquiry data is in correct categories/subcategories  
  New patterns, spikes and trends of inquiry types  
 
3.  Inquiry Tracking Rate  
MACs shall monitor their Inquiry Tracking Rate and compare:  
 
  Telephone Inquiries - (Total Telephone Inquiries in the Inquiry Tracking System/ 
Total PCC Calls Answered by CSRs) multiply by 100  
  Written Inquiries - (Total Written Inquiries in the Inquiry Tracking System/ Total 
Provider Written Correspondence Received to be Answered by the PCSP) multiply 
by 100  
 
CMS encourages each MAC to increase their rate.  
 
4.  MAC Provider Inquiry Tracking Updates 
MACs shall send CMS Provider Inquiry Tracking Updates to 
providerservices@cms.hhs.gov with the subject line "MAC Provider Inquiry Update," 
when the MAC finds: 
 
  Root causes for abrupt changes or spike throughout the month and any action 
take related to the issue. 
  Root causes for inquiry trends that last for at least two or more consecutive 
months and any actions taken related to the issue. 
 
5.  Inquiry Tracking Report Review and Validation 
MACs shall adhere to the requirements in Section 80.2.3.1 of this chapter to review 
the accuracy of the Inquiry Tracking Report before its submission to CMS. This 
    includes ensuring all new contractor-specific subcategories are properly documented 
before submitting data to CMS. 
 
30.9 - Fraud and Abuse 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
The term Medicare beneficiary identifier (MBI) is a general term describing a beneficiarys 
Medicare identification number. For purposes of this manual, MBI references both the Health 
Insurance Claim Number (HICN) and the 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 shall immediately send any provider inquiry or complaint about fraud and abuse, along 
with a referral package, to the Unified Program Integrity Contractor (UPIC). The referral 
package shall include: 
 
1.  Provider/Supplier name, NPI, provider/supplier number, and address. 
2.  Type of provider involved in the allegation and the perpetrator, if an employee of 
the provider/supplier. 
3.  Type of service involved in the allegation. 
4.  Place of service. 
5.  Nature of the allegation(s). 
6.  Timeframe of the allegation(s). 
7.  Narration of the steps taken and results found during the MACs screening process 
(discussion of beneficiary contact, if applicable, information determined from 
reviewing internal data, etc.). 
8.  Date of service, procedure code(s). 
9.  Beneficiary name, Medicare Beneficiary Identifier (MBI), telephone number. 
10. Name and telephone number of the MAC employee who received the complaint. 
 
This is not an all-inclusive list, the UPIC may request additional information to resolve the 
complaint/referral or during the subsequent development of a related case (for example, 
provider/supplier enrollment information). 
 
The MAC shall maintain a copy of all referral packages. 
 
40 - PCSP Staff Development and Education 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall be fully responsible for the education, development, evaluation, and management of 
PCSP staff.  This shall be accomplished by MACs providing initial and ongoing education and 
training of all PCSP staff.  Training for the PCSP staff should vary due to the wide spectrum of 
subjects, resources and tasks handled by the PCSP, and due to the level of complexity and nature 
of the workload the PCSP staff is or will be responsible to handle. In addition, MACs shall have 
    an education and development plan in place and documented for each staff member that 
addresses the education of new staff and the continued education and development of existing 
staff.  Education and reference materials and tools, as well as policy manuals, shall be made 
readily available and accessible to all staff.  MACs shall ensure that educational opportunities are 
afforded to all PCSP staff, and that staff are afforded promotion pathways through the design and 
implementation of the PCC and POE functions. 
 
40.1 - POE Staff Training 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
MACs shall implement a plan for training new POE personnel and periodically assess the 
training needs of existing POE staff.  The plan, which shall be written and available to the POE 
staff, shall include schedules, course or instruction vehicle descriptions, and satisfaction criteria.  
Training materials such as workbooks, manuals, and policy guidelines shall always be readily 
available to the POE staff. 
 
40.2 - PCC Staff Development and Training 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall provide training for all new PCC personnel and refresher training updates for 
existing personnel.  This training shall enable the CSRs to answer the full range of customer 
service inquiries and equip them with the knowledge and tools to meet CMSs performance 
requirements.  MACs shall have a training evaluation process in place for new hires and ongoing 
training to certify the CSR is ready to independently handle inquiries on the topics covered. 
 
Ongoing data analysis shall be used to determine training topics for PCC staff.  MACs shall 
consider data sources such as inquiry analysis, quality scores, monitoring results, and error rate 
data analysis when developing training topics.  The PRRS shall be involved in the development 
of training materials for the general inquiries staff.  Training shall be tailored to the level/degree 
of specialization of the CSR.  In addition to formal classroom training, regular feedback to CSRs 
and PRRS regarding their performance shall be a part of the staff development at the PCC. 
 
MACs shall ensure CSRs are equipped with the tools they need to handle providers inquiries 
while meeting CMSs performance requirements for telephone and written provider inquiries. 
These tools, at a minimum, shall include the use of the CMS website, the MACs provider 
education website and CMS-produced provider education materials. 
 
CMS will also continue to increase and improve the consistent national training information 
available to CSRs.  When available, MACs shall use training materials provided by CMS. 
Within 5 business days after receipt of CMS-developed standardized training materials or other 
CMS-developed information for use by CSRs, MACs shall initiate processes to implement these 
materials for all CSRs on duty and to ensure these materials will be implemented for those hired 
in the future. Since the development of these materials will be done by CMS, there will not be 
any costs to the MACs to use these materials. MACs may supplement the CMS-developed 
materials with their own materials as long as there is no contradiction of policy or procedures. 
 
    40.2.1 - Required Training for PCC Staff 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
In addition to the training topics determined by MACs, all MACs shall train their CSRs on the 
following topics at least once during the contract year.  If a CSR is hired after the training has 
occurred for the year, MACs shall include the training as part of their new hire training. MACs 
shall train their CSRs on the following: 
 
1. How to find, navigate and use their provider education website (including the MACs 
FAQs, the schedule of upcoming outreach and education events, and all available online 
education) and other self-service tools, to include the IVR system and the provider 
Internet-based portal.   
 
2. How to find, navigate and use the CMS website.  This includes the CMS FAQs and all 
online education resources provided through the MLN at https://www.cms.gov/Outreach-
and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.  
 
3. How to find, navigate, and use the PCSP website located at 
https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/Spotlight. 
This website strengthens MACs PCSPs by providing support information and 
documents, performance data, and helpful resources. 
 
4. The MLN.  (See section 20.4 of this chapter.)   
 
5. The CMS Standardized Provider Inquiry Chart categories, subcategories, and definitions, 
and they shall be trained to accurately log inquiry types according to the CMS 
Standardized Provider Inquiry Chart in the tracking system used by the MAC.  The CMS 
Standardized Provider Inquiry Chart is in the PCID database under Documentation.  
 
6.  The Privacy Act of 1974 and HIPAA. 
 
7.  The use of the Desk Disclosure Reference (DDR) Guide.  The DDR Guide provides 
MACs with information they need to authenticate Medicare providers and the access and 
disclosure guidelines to be followed when disclosing elements of PII or PHI to 
authenticated Medicare providers. The DDR Guide is available in the Documentation 
section of PCID.    
 
Education and training opportunities shall provide PRRS staff with the knowledge and tools to 
enable them to answer the full range of complex provider inquiries while meeting CMS 
performance requirements and standards for PRRS.  The PRRS will need specialized training in 
the use of the CMS Internet-Only Manuals, the CMS website, the http://www.medicare.gov/ 
website, the MACs provider education website, regulations, laws, and other information tools to 
accurately and completely respond to complex provider inquiries.  (PRRS also handle complex 
beneficiary inquiries.  See chapter 2 of this manual for information about complex beneficiary 
inquiries.) 
 
    See section 80.2.3 of this chapter for the monthly PCID reporting requirements. 
 
40.2.2 - PCC Training Program 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs may choose to close their PCCs to provide ongoing training for their CSRs, 
correspondents, and PRRS.  MACs may choose to close their PCCs to provide training or staff 
development for up to 8 hours per month per contract per jurisdiction (not per PCC call center 
location and not per application, queue, or toll-free line within a PCC).  The goal is to help PCC 
staff, particularly CSRs, improve the consistency and accuracy of their answers to provider 
questions, to increase their understanding of issues, and to facilitate retention of the facts of their 
training by increasing its frequency. 
 
Continuous training for PCC staff, particularly for CSRs and correspondents, is highly 
recommended.  MACs should implement an approach that best fits their operation and 
performance.  PCC training closures, as well as 8 hours of training each month, are not 
mandatory.  If a MAC closes its PCC for training, the requirements in sections 40.2.2.1  
40.2.2.5 of this chapter apply. 
 
The MACs shall adhere to the following guidelines when closing their PCC for training on days 
other than those listed in section 30.1.1 of this chapter: 
 
  The 8 hours per month shall be used for training only. 
 
  The 8 hours per month shall not be used for corporate meetings. 
 
  MACs shall assume approval of PCC closures for training that they have reported to 
PCID unless they receive notification to the contrary from CMS within 5 business days 
after the PCID reporting deadline. 
 
  Training time not used within a specific month shall not be carried over to the next 
month. 
 
  See section 80.2.3.2 of this chapter for the monthly PCID reporting requirements. 
 
   
40.2.2.1 - PCC Training Closure Determination 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
MACs shall perform an analysis to evaluate the appropriate time for PCC closure to anticipate 
the impact on their ability to meet all CMS performance requirements.  MACs shall consult their 
POE AG about the best hours for PCC training closures and training topics.  Training time 
closures shall not be the justification for poor performance. 
 
40.2.2.2 - Provider Complaints about PCC Training Time Closures 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
     
MACs shall monitor provider complaints about PCC training time closures and take action to 
resolve them and decrease the volume of complaints.  Reports about provider complaints and 
their resolution shall be kept on site and available to CMS upon request. 
 
40.2.2.3 - Provider Notifications of PCC Training Closures 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall notify providers of their PCC training closure times. At a minimum, MACs shall 
post a PCC closure notification for providers on their IVR system and their provider education 
website.  MACs with separate IVR and CSR lines shall post a PCC closure notification for 
providers on both lines.  In addition, note that MACs are required by section 50.1 of this chapter 
to include on their IVR system the hours of operation for telephone CSR service.  MACs shall 
use their electronic mailing list(s) to notify their provider community of their PCC training 
closure times. 
 
MACs shall notify providers of all PCC training closures or changes in their training closure 
schedule at least 2 weeks in advance of every PCC training closure date. 
 
40.2.2.4 - PCC Staff Feedback and MAC Evaluation of PCC Training 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
To assure that CSRs, correspondents, and PRRS are receiving the maximum benefit of the 
training program, MACs shall implement a process to evaluate the staffs progress on a monthly 
basis.  Also, MACs shall implement a process to evaluate the staffs retention of training 
information on a periodic basis.  MACs shall use pre-and post-training evaluation results and 
staff feedback to improve their training program. 
 
40.2.2.5 - PCC Training Documentation 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Copies of the MACs PCC staff training schedule, training plan, training materials, training 
assessments, training feedback and PCC staff attendance sheets, shall be made available to CMS 
upon request. 
 
50 - Provider Self-Service (PSS) Technology 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall use self-service and electronic communication technologies as efficient, cost-
effective means of disseminating Medicare provider information, education, and assistance. As 
such, MACs shall take every opportunity to market, educate providers about, and encourage the 
use of their self-service technologies. At a minimum, such educational opportunities shall 
include incorporating messages to providers in marketing materials, educational seminars, 
electronic mailing list messages, and instructions on the MACs provider education website and 
IVR system. 
 
    One important way to successfully manage the provider inquiry workload is to increase and 
enhance the self-service technology tools available to Medicare providers and to require 
providers to use these tools when appropriate. Use of self-service technology enables the PCCs 
to more efficiently handle provider calls by allowing providers access to certain information 
without direct personal assistance from MAC staff. MACs shall offer a variety of self-service 
options to providers including, but not limited to: 
 
1. IVR system for telephone inquiries. 
2. Provider education website. 
3. Web-based provider educational offerings. 
4. Electronic mailing lists. 
5. Social media, if used (usage is at the discretion of the MAC). 
6. Web technology (see the MAC Internet-based Provider Portal Handbook located at 
https://www.cms.gov/Medicare/Medicare-
Contracting/FFSprovCustSvcGen/downloads/Portal-handbook.pdf).      
 
MACs shall expand the use of their self-service options and offerings, as appropriate, and shall 
routinely analyze the options they offer, as well as the utilization of such offerings, in order to 
decide whether and how to expand those offerings. 
 
50.1 - Interactive Voice Response (IVR) System 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Although the provider shall have the ability to speak to a telephone CSR during normal PCC 
operating hours, automated self-help tools, such as IVR systems, shall also be used by all 
MACs to assist with handling inquiries.  IVR system service is intended to assist providers in 
obtaining answers to various Medicare questions, including those listed below: 
 
1. MAC hours of operation for telephone CSR service. 
 
2. After-hours message indicating normal business hours.  (It is not necessary to duplicate 
this message if the caller is informed of the normal business hours via the telephone 
system prior to being delivered to the IVR system.) 
 
3. General Medicare Program information. (MACs shall target individual message duration 
to be under 30 seconds.  MACs shall have the technical capability to either require callers 
to listen or to allow them to bypass the message as determined by CMS.  In cases where 
CMS makes no determination, the MAC shall use its own discretion.) 
 
4. Specific information about claims in process and claims completed.  (For claims status 
inquiries handled in the IVR system, all PCCs shall adhere to the Privacy Act of 1974 
and HIPAA Privacy Rule by authenticating providers as required by the Disclosure Desk 
Reference (DDR), which is referenced in section 80 of this chapter and is available in the 
Documentation Section of PCID.  
 
    5. Official definitions for the 100 most frequently used Remittance Codes as determined by 
each MAC.  (MACs are not limited to 100 definitions and may add more if their IVR 
system has the capability to handle the information.  This requirement may be satisfied 
by providing official Remittance Code definitions for specific provider IVR system claim 
status inquiries.) 
 
6. Routine eligibility information.  (Eligibility inquiries handled in the IVR system shall 
adhere to the Privacy Act of 1974 and HIPAA Privacy Rule by authenticating providers 
as required by the DDR, which is referenced in section 90 of this chapter and is available 
in the Documentation Section of PCID.  
 
At a minimum, the MACs shall require providers to use the IVR system to access claim status 
and beneficiary eligibility information; however, MACs have discretion to also require providers 
to use any other functionality available through the IVR.  Telephone CSRs shall refer providers 
to the IVR system for applicable questions.  Telephone CSRs may give the information if it is 
clear the IVR system is not functioning and the provider cannot access the information.  Each 
MAC shall update the IVR systems to address provider needs as determined through the MACs 
PCSP inquiry analysis at least once every 6 months. 
 
NOTE:  Each MAC has the discretion to also require providers to use the Internet-based provider 
portal for existing IVR functionality if the portal also has the same functionality. 
 
The IVR system shall be available to providers 24 hours a day, 7 days a week with allowances 
for normal claims processing and system mainframe availability, as well as normal IVR system 
maintenance.  When information is not available to IVR system users, MACs shall post a 
message alerting providers on the IVR system. 
 
MACs shall print and distribute a clear IVR system operating guide to providers upon request.  
The guide shall also be posted on the MACs provider education website.  MACs with a 
combined IVR/CSR configuration, shall ensure the guide details how callers can bypass the IVR 
and speak with a telephone CSR when they have general questions that do not require the caller 
to pass authentication or the caller does not have the required authentication elements (for 
example, consultants, attorneys, enrolling providers, etc.). As IVR system functionality changes, 
the operating guide shall be updated timely and the revisions posted to the provider education 
website. 
 
MACs shall report the IVR system type and options in PCID.  See section 80.2.2 of this chapter 
for PCID reporting and data certification requirements. 
 
50.2 - Provider Education Website 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall offer a provider education website as a PSS technology to serve as a self-help tool 
for Medicare providers in gaining information and assistance regarding the Medicare Program. 
This provider education website shall be dedicated to furnishing providers with timely, 
accessible, and understandable Medicare Program information. 
     
MACs shall consider the use of their provider education website for every educational offering 
they provide to Medicare providers, including approaches such as web-based conferencing and 
trainings and computer-based training.  However, MACs shall have solutions in place for 
providers who lack web access, such as hosting sites for web- and computer-based training.  (See 
section 20.4 of this chapter for the requirements to include MLN products or content, and the 
MLN Button.) 
 
 
 
 
50.2.1  General Requirements 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
The information contained on the MACs provider education website shall be structured in such 
a way information is easily found and searchable, so as to reduce the number of pages users have 
to go through in order to gain access to the information they are seeking.  In designing their 
websites, MACs shall adhere to basic, research-based website usability guidelines, including the 
use of plain language, a task-based design, and the elimination of redundant, outdated, and trivial 
content detected in periodic content audits. MACs shall also be aware of and adhere to federal 
website best practices found at www.digital.gov. 
 
To reduce costs, MACs shall use existing resources and technologies whenever possible. MACs 
shall provide a user interface for each jurisdiction to allow providers the ability to clearly find 
their specific jurisdiction on the provider education website and all of its contents.  MACs are 
ultimately responsible for the structure of their provider education website but shall design it so 
it is clear to providers they are accessing a provider education website for their particular 
jurisdiction and interest, specifically, A/B MAC, HH+H MAC, or DME MAC.  For example: 
 
Jurisdiction X A/B MACPart A, Part B 
Jurisdiction Y HH+H MACPart A, Part B, HH+H 
Jurisdiction Z DME MAC  DME 
 
MACs shall ensure information posted is current and does not duplicate information posted at 
http://www.cms.gov/ and http://www.medicare.gov/. MACs may post, on their own provider 
education website, LCD information that is contained in the Medicare Coverage Database.  (See 
Pub.100-08, Medicare Program Integrity Manual, section 13, which details the LCD provider 
education website posting requirements). 
 
MACs shall make improvements to, and ensure the integrity of, their provider education website 
on a continuing basis (for example, by ensuring section 508 compliance and correcting broken 
links). 
 
MACs shall have the capability to capture and report to CMS, by jurisdiction and by line of 
business (A, B, HH+H, DME), analytic data for their provider education website.  Analytic data 
include statistics on provider education website visits, page views, and on-site search queries.  
    See PCID documentation for definitions and more information.  This requirement is not 
applicable to MAC provider Internet-based portals. 
 
See section 80.2.3.10 of this chapter for the monthly PCID provider education website analytic 
data reporting requirements. 
 
50.2.2  Webmaster and Attestation Requirements 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall assign a Webmaster responsible for maintaining and updating relevant portions of 
the MACs provider education website in a timely manner.  The Webmaster shall ensure that the 
provider education website complies with CMSs Contractor Website Guidelines available at 
https://www.cms.gov/About-CMS/Agency-Information/Aboutwebsite/contractorwebguidlines.  
Webmasters shall pay close attention to the requirements for compliance with the requirements 
outlined in Section 508 of the Rehabilitation Act of 1973.  (See http://www.cms.gov/About-
CMS/Agency-Information/Aboutwebsite/Policiesforaccessibility.html.) 
 
See section 80.2.2 of this chapter for the PCID Webmaster identification reporting and data 
certification requirements. 
 
MACs shall periodically review the CMS Contractor Website Guidelines to determine their 
continued compliance.  Within 30 calendar days after a MAC contract cutover date of the MAC 
contract (if more than one cutover date, within 30 calendar days of the earliest cutover date), 
and, thereafter, by the end of the sixth month of a contract year, MACs shall send two statements 
from their Webmaster attesting their provider education website complies with: 
 
  CMS Contractor Website Guidelines.  
  Requirements stated in Pub. 100-04, Medicare Claims Processing Manual, chapter 23, 
section 20.7 regarding the use of Current Procedural Terminology (CPT)2 codes and 
descriptions. 
 
If a Webmaster determines the MACs provider education website is not in compliance with any 
of the CMS requirements, including the requirements outlined in Section 508, the MAC shall 
outline the steps it is taking to become compliant.  This information shall be submitted with the 
attestation statement. 
 
MACs shall submit their attestations using the appropriate MAC Deliverables mailbox. 
 
50.2.2.1  Website Governance 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
                                                 
2 CPT only copyright 2015 American Medical Association.  All rights reserved. 
    CMS and its contractor will conduct Website Governance scans to ensure MAC websites are 
compliant with Federal 504/508 policy as well as to search for dead URLs throughout the MAC 
webpages. MACs shall use the scan results as a tool to improve their individual MAC websites.   
 
CMS and its contractor will conduct monthly Website Governance scans of the MAC websites to 
ensure MACs comply with the U.S. Health and Humans Services (HHS) acceptable score 
(https://www.hhs.gov/sites/default/files/web/508/compliance/leaderboards/hhsleaderboard.html). 
MACs will also have the ability to run scans more frequently to test things like web updates or to 
test the resolution of any findings from the monthly scans.   
 
The overarching goal of the Website Governance Program is to give the MACs a tool to improve 
their individual MAC websites, which should translate into increased provider satisfaction. 
 
50.2.3  CMS Feedback 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Each MAC shall include the CMS regional office contact on its provider education website.   
 
MACs shall provide information about how providers can offer comments to CMS about the 
MACs performance in dealing with providers. Each MAC shall provide the email address of 
the resource mailbox at the CMS regional office that has jurisdiction over the MAC.  The 
resource mailbox address for each regional office, along with the MAC jurisdictions served by 
each regional office, is available under Feedback Mechanism found at 
https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/Contractor-
Resources. Users shall be able to easily reach this information from the provider education 
website.   
 
This feedback mechanism is separate from the feedback provided through the satisfaction 
surveys outlines in Section 60.1. 
 
50.2.4  Contents 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Each MACs provider education website shall consist of information that is easy to use and 
easily searchable and shall contain, at a minimum, the following: 
 
1.  Information on how to subscribe to the MACs provider electronic mailing list(s). 
 
2.  Frequently Asked Questions (FAQs), updated at least quarterly (see section 50.2.4.2 of 
this chapter for more information about the FAQs). 
 
3.  A schedule of upcoming POE activities (for example, seminars, workshops, fairs). 
 
4.  Ability to register for MAC-sponsored education and outreach activities. 
 
    5.  Search engine functionality. 
 
6.  A Whats New or similarly titled section that contains important information that is of 
an immediate or time sensitive nature. 
 
7.  A site map that shows in simple text headings the major components of the provider 
education website and allows users direct access to these components through selecting 
and clicking on the titles. This feature shall be accessible from the home page of the 
provider education website using the words Site Map. 
 
8.  A tutorial explanation of how to use the provider education website accessible from the 
home page.  The tutorial shall describe how to navigate through the provider education 
website and how to find information, and shall explain the features. The tutorial 
information can be on a help page as long as the help feature is accessible from the 
home page. 
 
9.  Information for providers on electronic claims submission. 
 
10. Information about the MAC, at a minimum including the telephone number(s) for 
provider inquiries, a fax number(s) for provider inquiries, and a mailing address for 
provider written inquiries. 
 
11. An IVR system operating guide. 
 
12. CMS products, articles and messages posted or linked, as directed.  
 
13. A feedback mechanism as described in section 50.2.3 of this chapter.  
 
14. The embedded link to MLN Connects as mentioned in section 50.2.4.1 of this chapter. 
 
15. MLN products or content links, and the MLN Button. 
 
16. Information from CMS for providers (see section 50.2.4.1 of this chapter.)  
 
17. A dedicated alerts page where providers can get information and educational 
announcements around claims processing issues including reprocessing/reopening claims 
due to under or overpayments (see Section 50.2.4.5 of this chapter) 
 
In addition, the provider education website shall contain the following links to other web 
addresses: 
 
1.  CMS website at http://www.cms.gov/.  
 
2.  CMS website at http://www.medicare.gov. (If a prominent part of the MACs provider 
education website or if a landing page on the MACs provider education website 
    references an individual(s) who is entitled to Medicare benefits, MACs shall use the term 
person(s) with Medicare to describe that individual(s). 
 
3.  Links to CMS social media pages  
 
  YouTube: https://www.youtube.com/user/CMSHHSgov   
  Twitter handle:  @CMSGov 
  RSS Feeds and Podcasts: https://www.cms.gov/Outreach-and-
Education/Outreach/CMSFeeds/index?redirect=/cmsfeeds/  
 
4.  MLN at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNGenInfo.  
 
5.  Sites for downloading CMS manuals and transmittals at 
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/index and 
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/index.  
 
6.  CMSs Quarterly Provider Update (QPU) web page at https://www.cms.gov/Regulations-
and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.  
 
7.  Website that contains descriptions for RA reason codes and remark codes at the official 
ASC X12 website. 
 
8.  CMSs HIPAA web page at https://www.cms.gov/Regulations-and-
Guidance/Administrative-Simplification/HIPAA-ACA/index.  
 
9.  CMSs central provider web page at https://www.cms.gov/center/provider-type/all-fee-
for-service-providers-center.html.  
 
10. CMSs ICD-10 web page at http://www.cms.gov/Medicare/Coding/ICD10/index.html. 
 
11. Other CMS Medicare contractors, partners, QIOs, and other websites that may be useful 
to providers. 
 
12. CMSs MREP Software information at https://www.cms.gov/Research-Statistics-Data-
and-Systems/CMS-Information-
Technology/AccesstoDataApplication/MedicareRemitEasyPrint.html.    
 
13. Provider Satisfaction Survey web page at https://www.cms.gov/Medicare/Medicare-
Contracting/MSI/index.   
 
MACs shall correct or remove specific information or links from their provider education 
websites when directed to do so by CMS. 
 
50.2.4.1  Dissemination of Information from CMS to Providers 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
     
MACs shall receive messages from CMS, via the MAC electronic mailing list(s) described in 
section 10.1 of this chapter.  The messages sent by CMS to the MACs via this electronic mailing 
list contain information for providers and instructions for the MACs on how, and sometimes 
when, to disseminate the information to providers.   
 
The instructions from CMS and the information for MACs to disseminate to providers contained 
within MLN Connects (weekly or Special Edition).  The instructions for the MACs are located 
below the heading Instructions to MACs and the information for the providers is located below 
the heading CMS Provider Education Message.  On occasion, CMS may include an Editors 
Note within the CMS Provider Education Message.  In such instances, MACs shall distribute 
the Editors Note along with the other content in the CMS Provider Education Message. 
 
When MACs distribute MLN Connects to providers via their electronic mailing list(s), MACs 
shall use the same format/medium (that is, web link, .pdf file) that CMS used to distribute it to 
the MACs. MACs may supplement MLN Matters Articles with localized information benefitting 
their provider community in billing and administering the Medicare Program correctly.  MACs 
shall post the direct link to the article on their website, bulletin, or newsletter (if published). 
 
If MACs have questions or concerns regarding the receipt or content of MLN Connects (weekly 
or Special Edition), they may send their questions or concerns to CMS at 
MLNConnectsMAC@cms.hhs.gov.  
 
1.  Timeliness of Dissemination of Information to Providers 
 
a.  Unless specifically directed otherwise in the instructions from CMS, MACs shall 
distribute the information to providers via their electronic mailing list(s) and post 
relevant information from CMS on their provider education website within 2 
business days after the date CMS sent the instructions and information to the 
MACs.  MACs shall include the information in their next MAC bulletin or MAC 
newsletter if the information is current at the time the MAC bulletin or MAC 
newsletter is published.  If the information is not current at that time, MACs have 
the discretion to include the information if they include a statement in the MAC 
bulletin or MAC newsletter that informs the readers that the information was 
included in MLN Connects (weekly or Special Edition) dated [MACs shall insert 
the date] and the information is being provided for informational purposes only 
because it was time-sensitive information or it is no longer applicable or in 
effect. 
 
b.  Urgent or time-sensitive information will be identified as such in the instructions 
from CMS.  Unless the urgent or time-sensitive information is identified by CMS 
as requiring immediate release or as requiring specific date and time of day 
release to providers, MACs shall distribute the urgent or time-sensitive 
information to providers via their electronic mailing list(s) and post relevant 
information from CMS on their provider education website by close of business 
the next business day after the date CMS sent the instructions and information to 
    the MACs.  MACs shall include the information in their MAC bulletin or MAC 
newsletter if the information is current at the time the MAC bulletin or MAC 
newsletter is published.  If the information is not current at that time, MACs have 
the discretion to include the information if they also include a statement in the 
MAC bulletin or MAC newsletter informing the readers that the information was 
included in MLN Connects (weekly or Special Edition) dated [MACs shall insert 
the date] and that the information is being provided for informational purposes 
only because it was time-sensitive information or it is no longer applicable or in 
effect.   
 
Urgent or time-sensitive information will be infrequent. 
 
  Urgent or time-sensitive information requiring immediate release 
If CMS identifies the information for providers as urgent or time-sensitive and 
requiring immediate release to providers, MACs shall distribute that information to 
providers via their electronic mailing list(s) and post relevant information on their 
provider education website no later than 2 hours after receipt of the instructions and 
information from CMS.  If the instructions and information from CMS are received 
by a MAC within 2 hours of the time the MAC would close for the day and the MAC 
is unable to distribute and post the information that day, the MAC shall distribute and 
post the information at the start of the next business day.  MACs shall include the 
information in their next MAC bulletin or MAC newsletter if the information is 
current at the time the MAC bulletin or MAC newsletter is published.  If the 
information is not current at that time, MACs have the discretion to include the 
information if they also include a statement in the MAC bulletin or MAC newsletter 
informing the readers the information was included in MLN Connects (weekly or 
Special Edition) dated [MACs shall insert the date] and the information is being 
provided for informational purposes only because it was time-sensitive information or 
it is no longer applicable or in effect.   
 
Urgent or time-sensitive Information that requires immediate release will be rare. 
 
  Urgent or time-sensitive information requiring specific date and time of day release 
If CMS identifies the information for providers as urgent or time-sensitive and 
requiring specific date and time of day release to providers, MACs shall distribute 
that information to providers via their electronic mailing list(s) and post relevant 
information on their provider education website on the specified date and at the 
specified time.  MACs shall include the information in their next MAC bulletin or 
MAC newsletter if the information is current at the time the MAC bulletin or MAC 
newsletter is published.  If the information is not current at that time, MACs have the 
discretion to include the information if they also include a statement in the MAC 
bulletin or MAC newsletter informing the readers the information was included in 
MLN Connects (weekly or Special Edition) dated [MACs shall insert the date] and 
the information is being provided for informational purposes only because it was 
time-sensitive information or it is no longer applicable or in effect.   
 
    Urgent or time-sensitive information that requires specific date and time of day 
release will be rare. 
 
2.  Distribution and Posting 
 
a.  Unless directed to do so by CMS (for example, in a TDL), MACs shall not edit 
or supplement the CMS information for providers. 
 
b.  MACs shall distribute and post all information received from CMS for providers 
and post relevant information on their provider education website.  If specified by 
CMS in its instructions to the MACs, MACs shall highlight information that is 
especially, or solely relevant, to a particular line of business (A/B, HH+H, or 
DME) or provider type (if the MAC has an appropriate targeted electronic 
mailing list for the specified provider type).  (See section 50.3.1 of this chapter 
for information about targeted electronic mailing lists.)  
 
c.  When distributing information from CMS to providers via their electronic 
mailing list(s), MACs shall clearly differentiate the information that was 
generated by CMS from other information that MACs send to them via their 
electronic mailing list(s).  In both the subject line of the electronic mailing list 
message and within the body of the electronic mailing list message, MACs shall 
make it clear to providers when the information is from CMS.  To avoid possibly 
confusing the providers, MACs shall omit from the subject line and the body of 
the message any reference to the actual CMS vehicle that transmitted the 
information to the MACs. 
 
d.  Occasionally, some information from CMS is related to a TDL.  When explicitly 
stated to do so in a TDL, MACs may use the information contained in a TDL to 
conduct normal operations in order to respond to inquiries from the provider 
community and to educate providers when appropriate, including the discretion 
to do local messaging as needed.  However, MACs shall not reference a TDL 
number. 
 
e.  The information for providers from CMS shall remain on the provider education 
website for 2 months or until the MAC bulletin or MAC newsletter in which the 
information is appearing (if the MAC publishes a bulletin or newsletter) is posted 
on the provider education website, whichever is later.  (See items 1.a. and 1.b. of 
this section for information about including the information in MAC bulletins or 
MAC newsletters.)  MACs have the discretion to remove information from the 
provider education website if it becomes outdated before the end of the 2-month 
period. 
 
f.  If CMS revises information MACs have already disseminated to providers, 
MACs shall ensure the revised information is distributed to providers via their 
electronic mailing list(s) and relevant information is posted on their provider 
education website within 2 business days after the date CMS sent the revised 
    information to the MACs (see item 1.a. of this section), or sooner if the 
information is urgent or time-sensitive (see item 1.b. of this section). 
 
g.  MACs shall ensure CMS information posted on their provider education website 
represents the most current information from CMS.  MACs shall remove the 
outdated information after receiving revised information from CMS.  If there is 
an accompanying CR that cancels information from CMS, MACs shall remove 
that information from their provider education website no later than close of 
business the next business day after the date the MAC received the CR from 
CMS. 
 
 
 
50.2.4.2  Frequently Asked Questions (FAQs) 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
All MACs shall maintain regularly updated local FAQs on their provider education website and 
link to the CMS FAQs for national information.   The FAQs are an important tool for the 
providers to use to get answers to their questions without contacting the PCC.  The MACs 
FAQs shall be updated for accuracy and relevance at least quarterly and the date an FAQ was 
last reviewed shall be noted on the provider education website.  MACs shall develop local FAQs 
based upon their data analyses described in section 20.3 of this chapter.  At a minimum, each 
MAC shall post FAQs based upon its jurisdictions Top 10 telephone and Top 10 written 
provider inquiries, claims submission errors, and MR topics. 
 
50.2.4.3 - Quarterly Provider Update (QPU) 
(Rev. 35, Issued: 10-07-16, Effective: 11-08-16, Implementation: 11-08-16) 
 
The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions 
issued by CMS that impact Medicare providers.  The QPU is maintained by CMS and available 
to providers through the CMS website.  Providers may elect to subscribe to a CMS electronic 
mailing list to be notified periodically of additions to the QPU.  MACs shall promote the 
existence and usage of the QPU and its electronic mailing list to their provider community. 
 
50.2.4.4 - Web-based Provider Educational Offerings 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall offer web-based training and educational resources, such as, but not limited to, 
computer-based training and webcasting, as self-help tools to acquire information about the 
Medicare Program. MACs shall encourage providers to use the CMS website and their provider 
education website for these offerings, as well as to subscribe to MAC electronic mailing lists so 
they can learn of them.  Materials from all webcasts shall be archived and made available, upon 
request, to providers who were unable to attend a webcast. 
 
50.2.4.5  Provider Claims Payment Alerts 
    (Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall develop and regularly update a dedicated webpage that alerts providers of confirmed 
system-related claims processing issues that have been identified by CMS, the MAC or the 
Shared Systems Maintainer.  The page shall provide information and educational announcements 
around claims processing issues that are currently active as well as provide an archive of 
resolved issues.  At a minimum the page shall include the following information for each 
reported issue: 
 
  Date Reported 
  Provider Type(s) Impacted 
  Reason Codes, as applicable 
  Claim Coding Impact (i.e. HCPCS/ICD codes etc.), as applicable  
  Description of the Issue 
  Action Required by the MAC, if any 
  Action Required by the Provider, if any 
  Proposed Resolution/Fix (including automatic reprocessing of claims or not) 
  Status (Open, Closed) 
  Date Resolved 
 
MACs may include additional jurisdiction-specific information providers may need in order to 
understand the issue. 
 
50.2.5  Provider Education Website Promotion 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall actively promote, market, and explain their Medicare provider education website 
and the information and features it contains, including the MLN resources discussed in section 
20.4 of this chapter.  Information about the MACs provider education website shall be part of, 
or made available at, all MAC POE workshops and seminars, training sessions with individual 
providers, and all other provider education activities a MAC arranges or in which it participates.  
MACs shall determine if their PCC may also be an effective way to promote their provider 
education website. 
 
50.3 - Electronic Mailing List  
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall offer electronic mailing lists to assist Medicare providers in gaining information 
about the Medicare Program.  These electronic mailing lists shall notify subscribers via email of 
important, time-sensitive Medicare Program information, upcoming provider communications 
events, and other announcements necessitating immediate attention.  CMS recommends MACs 
use electronic mailing list(s) for only one-way communication (i.e., from MACs to subscribers). 
MAC electronic mailing list(s), including information about subscribers (for example, email 
addresses) are the property of CMS and shall be shared with CMS upon request.   
 
1.  Subscribe/Unsubscribe 
     
Providers shall be able to subscribe or unsubscribe to electronic mailing list(s) via their 
MACs provider education website.  A MACs electronic mailing list(s) shall be capable 
of accommodating all of the providers served within the MACs jurisdiction. 
 
2.  Protection of Electronic Mailing Lists 
 
MACs shall protect electronic mailing list(s) addresses from unauthorized access or 
inappropriate usage.  Electronic mailing list(s), or any portions or information contained 
therein, shall not be shared, sold, or in any way transferred to any other organization or 
entity.  In special or unique circumstances where a MAC deems such a transference or 
sharing of electronic mailing list information to another organization or entity to be in the 
best interests of CMS or the Medicare Program, the MAC shall first obtain express 
written permission from its COR to transfer or share the information. MACs shall transfer 
electronic mailing lists(s), and all information contained therein, to incoming contractors 
during transition of a jurisdiction.   
 
3.  Electronic Mailing List Records 
 
MACs shall maintain usage records of their electronic mailing list(s).  These records shall 
include when the electronic mailing list(s) was used, the text of the messages sent, the 
number of subscribers to whom messages were sent (per message), the authors of the 
messages, and any transference or sharing that may have occurred (see item 2 above).  
Records shall be kept for 1 year from the date of usage. 
 
50.3.1 - Targeted Electronic Mailing Lists (Listservs) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Targeted electronic mailing lists shall be used to send messages and information regarding the 
Medicare Program, policies, or procedures of relevance or interest to specific provider 
audiences.  MACs shall use the list of provider types listed on the Medicare PE applications 
located at http://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/MedicareProviderSupEnroll/index.html to determine applicable and appropriate 
audiences. MACs may combine provider types listed on the PE applications or resort the 
provider types or create more finite provider type groupings, as necessary, to create targeted 
electronic mailing lists. 
 
50.3.2  Electronic Mailing List Promotion 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall actively market and promote the benefits of being a subscriber to the electronic 
mailing list(s) through the use of all regular provider communications tools and channels (for 
example, workshops, education events, POE AG meetings, ACTs, PCCs, and written materials).  
MACs shall consider having telephone CSRs subscribe providers to the electronic mailing list(s) 
during calls if the providers are not currently subscribed and the telephone CSRs believe the 
providers would benefit from the information provided through the electronic mailing list(s).  
    MACs shall also coordinate internally with other MAC departments to encourage electronic 
mailing list subscription. 
 
50.4  Social Media 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs may, at their discretion, use social media in their PCSP. Social Media are Web or cellular 
phone-based technologies that allow the sharing of information.  Social media include, but are 
not limited to, Facebook, YouTube, Twitter, and LinkedIn.  MACs who use social media shall 
market offerings on high priority CMS items and, if applicable, use any available CMS social 
media offerings. 
 
MACs who use social media shall submit their data in PCID.  See Section 80.2.3.11 of this 
chapter for the monthly PCID reporting requirements. 
 
50.5  MAC Internet-based Provider Portals 
(Rev.36, Issued: 07-21-17, Effective: 08-22-17, Implementation: 08-22-17) 
 
CMS has developed the MAC Internet-based Provider Portal Handbook located at 
http://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/downloads/Portal-
handbook.pdf.  MACs shall take into account the guiding principles outlined in the Handbook 
when redesigning or modifying their Internet-based provider portal.  CMS will notify MACs of 
updates to the MAC Internet-based Provider Portal Handbook via TDLs. 
 
50.5.1  Internet-based Provider Portal Service Interruptions 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall report Internet-based portal service interruptions to CMS as soon as they become 
aware of the issue.  MACs shall send an email to the Service Reports mailbox at 
servicereports@cms.hhs.gov with the subject Portal Interruption. The email shall describe the 
issue, the impact on service to providers and what is being done to resolve the issue.  Updates 
shall continue to be sent daily until the issue is resolved.   
 
Portal service interruptions include any unexpected portal downtimes or loss of one or more 
portal functions that cause the portal or function(s) to be unavailable to providers for any period 
of time.  If a portal service interruption adversely affects the PCC (for example, by increasing the 
call volume or by increasing the volume of written provider inquiries), the MAC shall send a 
Contractor Alert in accordance with the instructions in section 30 of this chapter.   
 
See section 80.2.3.8 of this chapter for the requirement to report portal service interruptions to 
PCID. 
 
60 - Surveys 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
    CMS requires MACs to complete periodic surveys about their PCSP operations, such as PCC 
technology, staffing profiles, and training needs.  Survey completion timeframes are dependent 
on the activity or service to be surveyed. 
 
60.1 - Provider Satisfaction Survey 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Executive Order (EO) 12862 requires Federal Agencies to be customer-driven by providing 
customer service equal to the best in business.  The EO tasks Agencies to survey customers to 
determine the type and quality of services they want and their level of satisfaction with existing 
services.   CMS complies with this EO by measuring providers satisfaction with the MACs 
performance using survey tools. MACs shall assist CMS in our effort to develop and implement 
these tools to meet this requirement. 
Currently, CMS uses the MAC Customer Experience (MCE) to survey providers.  The purpose 
of the MCE is to improve processes and procedures within the MACs and CMS based on the 
data CMS receives. The MCE program is not meant to provide a way for respondents to 
circumvent the MACs existing inquiry handling processes.  MACs may redirect respondents 
who leave contact information to the appropriate inquiry channels.  
 
60.1.1  MAC Survey Participation Requirements 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
At the request of CMS, MACs shall administer provider satisfaction surveys and: 
  Assign up to two points of contact for each jurisdiction to serve as liaisons between 
CMS and the MAC,  
  Participate in meetings, conference calls, focus group evaluations and in-depth 
interviews with CMS and the Survey Contractor to implement and manage the 
satisfaction surveys and analyze the results; 
  Assist in developing/refining survey tools by: 
  Providing insight on what information is important to collect 
o
  Testing/piloting new survey tools  
o
  Suggesting innovative survey tool strategies and technologies 
o
  Develop MAC specific questions for the satisfaction survey, as instructed by CMS 
  Add code from the Survey Contractor to the MACs website and portal and initiate 
action to activate the code as instructed by CMS; 
  Make surveys available to MAC customers by: 
  Publishing custom survey URLs to websites and portals as directed 
o
  Distributing custom survey URLs via direct email, electronic mailing lists, 
o
social media, or other communication channels, as directed  
  Adding survey access (for example, URLs, QR codes) to written or other 
o
forms of communication, when applicable 
  Review survey results on a regular basis;  
  Perform ongoing marketing and outreach for the survey by: 
      Disseminating information about the survey on electronic mailing lists and 
o
other provider communications channels, as appropriate. 
  Posting information about the survey on provider education websites, provider 
o
Internet-based portals, social media channels, and IVR messaging.  
Promoting the survey at conferences, webinars, workshops, events, and meetings. 
 
60.1.2  Continuous Improvement 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
At least two MAC POCs shall maintain access to the Survey Contractors portal to view survey 
results on a regular basis and conduct analysis of the data to ensure provider satisfaction.  Based 
on this analysis, MACs shall develop and implement plans to improve the providers overall 
customer experience with the MAC.   At minimum every 6 months MACs shall post information 
on their websites about operational changes/improvements made in response to survey feedback 
since the previous update. 
 
60.1.3  Closed-Loop Ticketing 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Closed-Loop Ticketing enables MACs to create follow-up tickets to track and resolve issues and 
comments from their survey feedback.  Each MAC shall use the closed-loop ticket system 
provided by CMS.  A ticket generates when a response is submitted and when certain criteria are 
met based on each survey. Every ticket does not require a personalized response, even if a 
respondent leaves contact information.  
 
MACs have the discretion about how to close a ticket including, but not limited to: 
  Sending a personalized email response to close the ticket or initiate a discussion with the 
respondent 
  Sending a canned response explaining what resources are available to resolve a 
respondents issue (for example, directing them to a resource on your website) 
  Sending a canned response directing the respondent to the appropriate inquiry mechanism 
to resolve their issue (for example, directing them to the PCC or Portal Help Desk) 
  Sending a canned response thanking the respondent for their feedback when contact 
information is provided, but a response is not needed 
  Closing the ticket because a response is not needed and no contact information is 
provided 
 
60.1.4  Survey Response Prohibition  
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
At the beginning of each calendar year, MACs shall send a written communication to employees 
and subcontractors stating its employees and those of its subcontractors are prohibited from 
taking the MACs own satisfaction survey or the satisfaction survey of any other MAC. Upon 
request from CMS, each MAC shall furnish documentation of those written communications. 
 
    60.1.5  MCE User Guide 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
 
MACs shall follow the MCE User Guide.  The MCE User Guide serves as a reference to help the 
MACs implement and administer their MCE programs.  Information in the MCE User Guide 
includes, but is not limited to, platform access instructions, reporting instructions and system 
support.  The MCE Guide is found in the Brand Admins Library on the MCE survey platform.  
 
60.1.6 - Third-Party Contractor Platform System Users  
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Each MAC shall identify two staff who will serve as Administrators.  These individuals will 
have the highest level of access in the Survey Contractors online platform and will be 
responsible for overseeing staff access to the platform.  This includes assigning user accounts, 
deactivating users who no longer need access and maintaining signed and dated copies of the 
survey contractors FedRAMP Rules of Behavior.  MACs may maintain this document 
electronically or in hard copy and shall make it available to CMS upon request.  Within five days 
of being assigned as a MAC Administrator, each Administrator shall sign and date the survey 
contractors FedRAMP Rules of Behavior and forward a copy to MCE@cms.hhs.gov.  MACs 
shall notify CMS about changes to Administrators and submit new signed agreements for new 
Administrators within five days of the change. 
 
60.2  MAC Satisfaction Score 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Satisfaction with the services provided by MACs shall be monitored throughout the contract year 
for each jurisdiction using the results from the MCE survey. In addition to measuring satisfaction 
with individual MAC functions (for example, appeals, digital services, PE) the MCE provides an 
overall MAC satisfaction score per jurisdiction called the MAC Satisfaction Score.  Using this 
score each MAC jurisdiction shall achieve an average score of 3.6 out of 5.0 for their contract 
year. The MAC Satisfaction Score is derived from the Shared Dashboard within the Survey 
Contractor Platform and measures the average score for the entire contract year. 
 
70 - PCSP Performance Management 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
70.1 - POE  Electronic Mailing List Subscribership 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
This section is not applicable to targeted electronic mailing lists described in section 50.3.1 of 
this chapter. 
 
MACs shall promote their electronic mailing list(s) to providers as much as possible including 
using their events, website and association partnerships.  
     
MACs shall, to the extent possible, eliminate duplicate email addresses in their electronic 
mailing list subscribership.   
 
70.2 - Telephone Standards 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Each MACs PCC is held accountable for meeting call handling and quality standards, such as 
call completion rates, average speed of answer, and quality call monitoring.  All calls handled by 
a MACs PCC contribute to that MACs success or failure in meeting the standards described in 
sections 70.2.1  70.2.6 of this chapter. 
 
 
70.2.1 - Call Completion 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
  Each CSR/IVR combined line shall have a completion rate of no less than 80 percent.  This 
standard is measured quarterly and is cumulative for the quarter. 
 
  Each CSR-only line shall have a completion rate of no less than 80 percent.  This standard is 
measured quarterly and is cumulative for the quarter. 
 
  Each IVR-only line shall have a completion rate of no less than 95 percent.  This standard is 
measured quarterly and is cumulative for the quarter. 
 
  MACs shall send an email to the Service Reports mailbox at servicereports@cms.hhs.gov by 
11:00 a.m. ET if their PCC completion rate for the previous business day was less than the 
applicable standards described above.  The email shall report the decreased completion rate 
roll-up for the jurisdiction and the decreased completion rate by individual toll-free number 
and shall identify the MACs toll-free number by MAC name, jurisdiction, line of business, 
configuration (IVR, CSR, IVR/CSR), and numerical toll-free number.  The email shall also 
specify if the completion rate was impacted by staffing, call volume, or technical 
telecommunications or connectivity issues.  The email shall be sent with the subject line 
Completion Rate. 
 
70.2.2 - Call Acknowledgment 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20)) 
 
Calls shall be acknowledged within 20 seconds by a telephone CSR, IVR, or ACD prompt. 
 
70.2.3  Average Speed of Answer (ASA) 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
The average speed of answer (ASA) is the average time callers spend in the telephone CSR 
queue waiting to be connected to a telephone CSR.   When determining the ASA, the wait time 
    begins when the caller enters the telephone CSR queue and ends when the caller is connected to 
a telephone CSR.  MACs are held to quarterly ASA performance standards on their PCC line(s).  
The ASA standard is applied to the speed at which the initial call is answered by a telephone 
CSR.  Should the caller need to be transferred to another level CSR, the time associated with that 
transfer shall not be included in the ASA calculation.  MACs shall maintain an ASA of 60 
seconds or less.  This standard is measured quarterly and is cumulative for the quarter.  
 
MACs shall send an email to the Service Reports mailbox at servicereports@cms.hhs.gov by 
11:00 a.m. ET if the ASA on the PCC line(s) was higher than the applicable quarterly standard 
for the previous business day.  The email shall specify the overall ASA for the jurisdiction and if 
the elevation in ASA was impacted, or partially impacted, by staffing, call volume, or technical 
telecommunications or connectivity issues.  The email shall be sent with the subject line ASA. 
 
70.2.4  Callbacks 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall ensure telephone CSRs collect necessary information from a caller to perform 
research and respond.  For callback completion and closeout, MACs shall make one attempt to 
reach a provider.  The MAC may leave a message requesting a return call, including the 
reference number and beneficiarys name if appropriate, but no other PHI or PII shall be left on 
the message. MACs shall not leave responses on provider voicemail systems. If the MAC cannot 
leave a message then the MAC shall send a written response referencing the inquiry, date and 
time of the callback attempt, and request the provider call the MAC if they still need assistance 
to resolve their inquiry. Once the MAC has attempted to reach the provider, either thru the 
phone or written response, the callback is considered completed and closed.   
 
All callbacks shall be completed and closed out within 10 business days of receipt of the original 
inquiry and documented in the inquiry tracking system, discussed in section 30.8 of this chapter. 
MACs shall not have a telephone CSR callback rate greater than 10 percent for those telephone 
inquiries handled by CSRs. The standard is measured monthly and is cumulative for the quarter.  
A callback shall be considered completed and may be closed out if a final response has been sent 
to the provider or if the MAC has informed the provider the inquiry was escalated to a different 
department within the MAC for resolution.  Inquiries not closed out within 10 business days of 
receipt of the original inquiry are considered untimely. 
 
70.2.5  QCM Performance Standards 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall monitor a minimum of five telephone calls per telephone CSR per month per 
jurisdiction.  Any deviation from this requirement shall be documented by the PCC.  
Documentation shall be maintained in the event the number of calls monitored is questioned. 
 
  For all calls monitored for the quarter, the percent scoring as Pass shall be no less than 93 
percent for Adherence to the Privacy Act.  This standard is measured quarterly and is 
cumulative for the quarter. 
 
      For all calls monitored for the quarter, the percent scoring as Achieves Expectations or 
higher shall be no less than 93 percent for Customer Skills.  This standard is measured 
quarterly and is cumulative for the quarter. 
 
  For all calls monitored for the quarter, the percent scoring as Achieves Expectations or 
higher shall be no less than 93 percent for Knowledge Skills.  This standard is measured 
quarterly and is cumulative for the quarter. 
 
70.2.6  QAM (Telephone) Performance Standard 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The quality of telephone CSR responses to provider telephone calls shall be monitored 
throughout the contract year for each MAC jurisdiction using QAM (Telephone).  The goal of 
QAM (Telephone) is to ensure the telephone CSRs provide accurate and complete information, 
in a courteous and professional manner, while ensuring that information is released to those 
authorized to receive it.  As stated in section 30.4.10.2 of this chapter, QAM (Telephone) 
monitoring shall be conducted by the CMS independent monitoring contractor. 
 
Each MAC jurisdiction shall achieve an average quality rate of at least 93% for the contract year. 
 
The quality rate is determined by dividing the total number of QAM scorecards marked as 
Passed by the total number of QAM scorecards completed during the contract year.  With 
respect to A/B MACs whose contracts include HH+H work, the CMS independent monitoring 
contractor shall generate separate scorecards and totals for A/B calls and for HH+H calls but 
these scorecards shall be combined to determine the total number of scorecards completed, the 
total number of scorecards passed, and the total number of scorecards failed for the jurisdiction. 
 
70.3  Standards for Written Responses to Provider Inquiries 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall evaluate the responses to written provider inquiries by employing CMSs QWCM 
process.  If a written CSR responds to types of inquiries that are not handled by the PCC, those 
responses shall not be included in the required minimum number of responses evaluated and 
entered into the QWCM database. 
 
70.3.1 - QWCM Performance Standards 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall evaluate and enter into the QWCM application a minimum of five provider 
responses per written CSR per month per jurisdiction or the entire universe available for 
monitoring, whichever is less, regardless of the different addresses to which inquiries may be 
sent.  Any deviation from this requirement shall be documented by the PCC.  Documentation 
shall be maintained in the event the number of responses monitored is questioned.  MACs shall 
meet the following standards: 
 
      For all written provider responses monitored for the quarter, the percent scoring as Pass 
shall be no less than 93 percent for Adherence to the Privacy Act. This standard is 
measured quarterly and is cumulative for the quarter. 
 
  For all written provider responses monitored for the quarter, the percent scoring as 
Achieves Expectations or higher shall be no less than 93 percent for Customer Skills. 
This standard is measured quarterly and is cumulative for the quarter. 
 
  For all written provider responses monitored for the quarter, the percent scoring as 
Achieves Expectations or higher shall be no less than 93 percent for Knowledge Skills. 
This standard is measured quarterly and is cumulative for the quarter. 
 
70.3.2  Timeliness of Responses to Written Provider Inquiries 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Standards for responding timely to provider written inquiries (general, PRRS and Congressional) 
are calculated using business days.  See the chart below for assistance with converting calendar 
days to business days.  This chart is provided as a guide only and is not definitive.  The chart 
assumes the MAC was open for business every day during the reporting period.  Days where the 
MAC is closed for business shall not count as business days. 
 
Business  Calendar 
Days  Days 
5  7 
10  14 
15  21 
20  28 
25  35 
30  42 
35  49 
40  56 
45  63 
 
70.3.2.1 - Timeliness of Responses to General Provider Inquiries 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
All general written provider inquiries (including those received electronically) shall be 
responded to in writing or by telephone within 45 business days of receipt. 
 
This timeframe begins the day the inquiry is originally received and date-stamped by the MAC 
and ends the day the MAC sends the final response.  For those general inquiries that cannot 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 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 sent to general inquiries will count toward the 
MACs overall allowance of no more than 5 percent of interim responses for the universe of 
written responses to provider inquiries. 
 
There may be instances when an inquiry is mistakenly sent to another address used by the MAC.  
The 45-business-day timeframe will begin once the inquiry is received in the MAC mailroom 
where written inquiries are routinely sent.  This does not apply to MACs who choose to have all 
of their mail sent to a separate location and then forwarded to the proper location.  For these 
MACs, the 45-business-day timeframe starts the day that the mail is received at the initial 
location. 
 
The 45-business day timeframe is applicable to inquiries that require a response related to any 
claim type for which the MAC is responsible (A/B, HH+H, DME).  Therefore, if applicable, the 
MAC shall ensure that inquiries are provided to more than one responding department as quickly 
as possible.  The response to these inquiries may be combined or separate, depending on which 
procedure is most efficient for the MAC.  If the MAC departments respond separately, each 
response shall refer to the fact that the other department is also sending a response. 
 
70.3.2.2 - Timeliness of Responses to Complex Provider Inquiries (PRRS) 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The PRRS staff shall provide clear and accurate answers to provider inquiries within 45 business 
days of receipt. 
 
This timeframe begins the day the inquiry is originally received and date-stamped by the MAC 
and ends the day the MAC sends the final response.  For those PRRS inquiries that cannot 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 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 sent to PRRS inquiries will count toward the MACs 
overall allowance of no more than 5 percent of interim responses for the universe of written 
responses to provider inquiries. 
 
70.3.2.3 - Timeliness of Responses to Complex Beneficiary Inquiries (PRRS) 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Refer to chapter 2 of this manual for information about the timeliness of responses to complex 
beneficiary inquiries. 
 
 
70.3.2.4 - Timeliness of Responses to Congressional Inquiries 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
    All Congressional written inquiries shall be responded to in writing within 10 business days of 
receipt. 
 
This timeframe begins the day the inquiry is originally received and date-stamped by the MAC 
and ends the day the MAC sends the final response.  For those Congressional inquiries that 
cannot be answered in final within 10 business days of receipt, MACs shall issue an interim 
response within 10 business days of receipt explaining the reason for the delay, including 
indicating how the Congressional office can contact the MAC to check on the status.  When 
possible, inform the Congressional office about how long it will take 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 sent to Congressional inquiries 
will count toward the MACs overall allowance of no more than 5 percent of interim responses 
for the universe of written responses to provider inquiries. 
 
80 - PCSP Data Reporting 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
The PCSP System is an interactive web-based tool that is password protected and accessible only 
to authorized users.  The system includes four databases:  PIES, PCID, QCM, and QWCM. 
 
Upon a jurisdiction award, the MAC shall identify a Database Supervisor and an alternate for 
each of the four databases. Each Database Supervisor and alternate shall assume responsibility 
for approving, denying, and maintaining MAC staff access to the PCSP System database(s) for 
which he/she is responsible.  A Database Supervisor and alternate may have responsibility for 
more than one PCSP System database.  Within 30 calendar days after the first MAC cutover 
date, the MAC jurisdiction shall furnish CMS with the name, telephone number, and email 
address of the Database Supervisor and alternate for each PCSP System database by sending an 
email containing that information to the Provider Services mailbox at 
providerservices@cms.hhs.gov, with the subject:  Database Supervisor.  If the 30th calendar 
day falls on a weekend or holiday, the MAC shall send the information by close of business the 
next business day.  
 
After CMS receives the names of the Database Supervisors and alternates, CMS will send them 
the PCSP System User Access Request Form to fill out and return to CMS to the Provider 
Services mailbox at providerservices@cms.hhs.gov, with the subject: PCSP System Access 
Form.  Once the form is returned and the request is approved by CMS, the Database 
Supervisors and alternates will have access to the requested PCSP System database(s) and shall 
begin assuming PCSP System database access responsibility for other MAC staff in accordance 
with sections 80.1.1, 80.2.1, 80.3.1 and 80.4.1 of this chapter.  The PCSP User Access Request 
Form can be found in the documentation section of each of the PCSP System databases. 
 
 80.1 - PIES 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
    CMS collects and displays PCC performance data on a monthly basis.  These data are collected 
through PIES.  Definitions, calculations and additional information for each of the required data 
elements as well as associated standards are posted on the PIES website.  PCCs shall regularly 
review and use their performance data to improve their overall performance. 
 
MACs shall report data by jurisdiction and, where necessary, by queue.  (See section 30.4.1 of 
this chapter.) 
 
80.1.1 - Access to PIES 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The PIES is an interactive web-based tool that is password protected and accessible only to 
authorized users.  To help ensure the integrity of the data, CMS limits the number of user 
accounts per contract (A/B, HH+H, DME).   
 
MAC staff who need access to PIES shall request access by filling out the PCSP System 
User Access Request Form and submitting it to their appropriate Database Supervisor or 
alternate. Upon the discretion of the Database Supervisor or alternate, the Database 
Supervisor or alternate shall either grant access or deny access to PIES for the requesting 
MAC staff. The Database Supervisor or alternate may grant access to the same person for 
more than one contract. The Database Supervisor or alternate shall keep a copy of all 
completed PCSP System User Access Request Forms.  All copies of completed PCSP 
System User Access Request Forms shall be made available to CMS upon request.  
 
If MAC staff no longer need access to the PIES database, the Database Supervisor or 
alternate shall archive those users in the database. The Database Supervisor or alternate 
shall review the database monthly to identify and archive MAC staff who no longer need 
access. 
 
The Database Supervisor or alternate shall ensure that all MAC staff who need access to 
PIES have access within 30 calendar days after the first cutover date.  
 
80.1.2 - Due Date for Data Submission to PIES 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Each PCC shall enter required PCC data elements into PIES on a monthly basis between the 1st 
and 10th of each month for the previous month.  Because the data on the number of callbacks 
closed within 10 business days may not be available by the 10th of the month, MACs shall report 
callback data via the PIES Callback Data entry form, which is available to the MACs each month 
from the 11th through the 16th as a link in the PIES menu. 
 
After the 10th of the month, the data entry capability will no longer be available to the MACs.  
After the 10th of the month, any missing data will be considered late and will need to be entered 
into PIES by CMS staff.  Callback data is not considered late until after the 16th of the month. 
 
    If a MAC did not report data timely, the MAC shall inform CMS of the data to be entered into 
PIES by submitting that information within 2 business days after it becomes available to the 
PIES mailbox at pie-system@cms.hhs.gov.   
 
If a MAC entered data timely but, after the PIES reporting due date, determined that the data 
needed to be changed, the MAC will not be able to change the data; the changed data will need 
to be entered by CMS staff.  In this situation, MACs shall inform CMS of the data to be changed, 
the reason(s) for the change(s), and the field(s) to be changed.  This information shall be 
submitted to the PIES mailbox at pie-system@cms.hhs.gov.  
 
80.1.3 - Data to be Reported Monthly in PIES 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
  Telephone inquiries data:  MACs shall capture and report in PIES the data elements 
appropriate for their MAC profile (CSR- and IVR-only lines or a combined CSR/IVR 
line). 
 
  Written inquiries data:  MACs shall capture and report in PIES the data elements 
specified in the PIES database related to their general, PRRS, and Congressional written 
inquiries. 
 
  Provider Internet portal data:  MACs shall capture and report in PIES the data elements 
specified in the PIES database related to their provider Internet portal services. 
 
The list of data elements and their corresponding definitions are available in the PIES Database. 
 
80.2 - PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The PCID is a secure web-based system developed to serve as a central place to capture and 
store information about MACs PCSP activities as well as provide an online reporting 
mechanism for the MACs inquiry tracking reports.   
 
MACs with more than one jurisdiction shall have the ability to separately identify provider data 
for each jurisdiction in order to accurately report this information in PCID. 
 
80.2.1 - Access to PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The PCID is an interactive web-based tool that is password protected and accessible only to 
authorized users.   
 
MAC staff who need access to PCID shall request access by filling out the PCSP System 
User Access Request Form and submitting it to their appropriate Database Supervisor or 
alternate.  Upon the discretion of the Database Supervisor or alternate, the Database 
Supervisor or alternate shall either grant access or deny access to PCID for the requesting 
    MAC staff.  The Database Supervisor or alternate may grant access to the same person for 
more than one contract.  The Database Supervisor or alternate shall keep a copy of all 
completed PCSP System User Access Request Forms. All copies of completed PCSP 
System User Access Request Forms shall be made available to CMS upon request.  
 
If MAC staff no longer needs access to the PCID database, the Database Supervisor or 
alternate shall archive those users in the database. The Database Supervisor or alternate 
shall review the database monthly to identify and archive MAC staff who no longer need 
access.   
 
The Database Supervisor or alternate shall ensure that all MAC staff who need access to 
PCID, have access within 30 calendar days after the first cutover date. 
 
 
 
 
80.2.2 - MAC Contract and PCSP Data to be Reported in PCID 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall be responsible for entering and maintaining the following MAC contract and PCSP 
data in PCID: 
 
  IVR System Information 
  MAC Mailing Address 
  MAC Provider Education Website Address 
  Written Inquiry Storage Location (Primary, Alternate) 
  PCC Toll-free Numbers (Each Toll-free Number at Each PCC Location)  Line(s) of 
Business and Program Area Applications Handled (A, B, HH+H, DME, Appeals, EDI, 
PE, other), and Use (CSR, IVR, TDD) 
  MAC PCSP Points of Contact and Contact Information 
  PCSP Program Manager  
  POE Contact (Primary) 
  PCC Contacts 
  Webmaster 
  MLN Connects Contact 
  MAC Liaisons (for MAC-to-MAC collaboration) 
  Pre-Approved PCC Closures  MACs shall report PCC closures that fall on CMS pre-
approved days and any other planned PCC closure dates the reasons for the closures. 
 
MACs shall report the above data to PCID within 60 calendar days after the cutover date of the 
MAC contract (if more than one cutover date, within 60 calendar days after the earliest cutover 
date) or, if the data is not available at that time, within 7 calendar days after the data become 
available.  If a due date falls on a weekend or holiday, the information is due by close of business 
on the next business day. 
 
    On a monthly basis, MACs shall review these data in PCID, make updates or changes as 
necessary, and certify that the data is correct. 
 
80.2.3  Additional Data to be Reported Monthly in PCID and Reporting Due 
Dates 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall report in PCID the data described below in sections 70.2.3.1  70.2.3.10 of this 
chapter on a monthly basis between the 1st and the 10th of each month for the previous months 
data and, for certain data required by section 70.2.3.2 of this chapter, between the 1st and the 10th 
of the month for the upcoming month.  After the 10th of the month, the data entry capability will 
no longer be available to the MACs.  After the 10th of the month, any missing data will be 
considered late and will need to be entered into PCID by CMS staff.  If a MAC did not report 
data timely, the MAC shall inform CMS of the data to be entered into PCID by submitting that 
information within 2 business days after it becomes available to the PCID mailbox at 
pcid@cms.hhs.gov.  
 
If the MAC entered data timely but, after the PCID reporting due date, determined the data 
needed to be changed, the MAC will not be able to change the data; the changed data will need 
to be entered by CMS staff.  In this situation, MACs shall inform CMS of the data to be changed, 
the reason(s) for the change(s), and the field(s) to be changed.  This information shall be 
submitted to the PCID mailbox at pcid@cms.hhs.gov.  
 
80.2.3.1  Inquiry Tracking Data to be Reported in PCID 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall log all PCSP inquiries in their Inquiry Tracking System and enter them in the PCID 
Inquiry Tracking module between the 1st and the 10th of each month for the previous months 
data. 
 
1.  MACs shall include all PCC triage levels (Level 1, Level 2, PRRS), all PCC queues 
and sites, and inquiries handled by the PCC (i.e., general inquiries, escalated inquiries 
within CSR tiers, Congressional) including inquiries handled by other functions under 
the PCC (for example, PE, Appeals, EDI, Reopening) in the Inquiry Tracking Report. 
MACs shall ensure any automatic programs that consolidate data from other 
functions captures all required data. 
 
2.  MACs shall not duplicate the inquiry count reported to CMS except when MACs 
transfer inquiries from a telephone to a written response. 
 
3.  MACs shall ensure they report all required information about any contractor-specific 
subcategories created during the month.  See Section 30.8.D for more information on 
contractor-specific subcategory development. 
 
4.  MACs shall use the PCID comment field to inform CMS about relevant information 
impacting their monthly data submission.  Examples of information to include: 
    i.  MAC PCSP/PCC transition 
ii.  Inquiry Tracking System transition 
iii.  Root causes for abrupt changes or spikes in PCC inquiries 
iv.  Root causes that impact the volume or trends of provider inquiries (for 
example, emergency conditions in the jurisdiction, specific initiatives/pilots, 
processing errors, system issues) 
  
5.  MACs shall certify in PCID all MAC Inquiry Tracking Data Review and Validation 
Procedures as described in Section 30.8.2 have been completed before submitting the 
monthly data.  (CMS acknowledges further analyses is required to complete the 
inquiry analyses cycle; however, the objective of the attestation is to assure minimum 
procedures have been completed before submitting the Inquiry Tracking Report to 
CMS). 
 
80.2.3.2  PCC Training Closure Information to be Reported in PCID 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall report PCC training closure information in PCID on a monthly basis between the 1st 
and the 10th of each month for PCC training closures planned for the upcoming month (if any) 
and for PCC training closures that occurred in the previous month.  MACs shall report the 
following information for each PCC training closure: 
 
  Date, start and end times, and location of PCC training closures for the upcoming month 
if any such closures are planned.  If no such closures are planned for the upcoming 
month, the MAC shall send an email to the Provider Services mailbox at 
providerservices@cms.hhs.gov indicating that it has no plans to close for PCC training 
during business hours in the upcoming month; 
 
  Topics and subtopics of CSR training that occurred in the previous month; and, 
 
  Categories and subcategories (from the Standardized Provider Inquiry Tracking Chart) 
that correspond to the CSR training that occurred in the previous month. 
 
Reporting example:  By July 10, MACs shall report planned training dates, start and end times, 
and locations for PCC training closures for the month of August. At the same time, MACs shall 
report training topics and subtopics, and standardized provider inquiry categories and 
subcategories for training that occurred for the month of June. 
 
80.2.3.3  POE Data to be Reported in PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall enter POE event and self-paced education data in PCID on a monthly basis between 
the 1st and the 10th of each month for the previous months data. 
 
Definitions, additional instructions, and the POE Topic/Subtopic listing are available in the 
Documentation section of PCID. 
     
MACs with multiple jurisdictions shall report POE event data and self-paced education data by 
jurisdiction. More information on reporting POE event and self-paced education data and their 
definitions can be found in the PCID Quick Start Guide. The PCID Quick Start Guide is 
available in the Documentation Section of PCID. 
 
80.2.3.4  Provider Electronic Mailing List Subscriber Data to be Reported in 
PCID 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
Each MAC shall enter provider electronic mailing list subscriber data in PCID on a monthly 
basis between the 1st and the 10th of each month for the previous months data.  To the extent 
possible, MACs shall report the number of unique (non-duplicated) subscribers.  This reporting 
requirement does not apply to MACs targeted mailing lists described in section 50.3.1 of this 
chapter. 
 
HH+H MACs shall separately report the number of subscribers to their A/B and HH+H 
electronic mailing lists; these numbers shall not be combined. 
 
It is not necessary for MACs to report the number of electronic mailing list subscribers in their 
Monthly Status Reports. 
 
80.2.3.5  Special Initiatives Activities to be Reported in PCID 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
When CMS issues TDLs requiring MACs report on activities related to special initiatives, MACs 
shall enter their special initiatives activities in PCID on a monthly basis between the 1st and the 
10th of the month for the previous months data.  Special initiatives activities may include direct 
mailings, electronic mailing list messages, POE events, website postings, or IVR system 
messages. 
 
80.2.3.6  Emergency and Similar PCC Closure Data to be Reported in PCID 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
If an emergency or similar PCC closure occurred (see section 30.1.3 of this chapter), the MAC 
shall enter that closure in PCID between the 1st and the 10th of the month for the previous 
months data.  No reporting is necessary for months in which there were no such closures. 
 
80.2.3.7  Telecommunications Service Interruptions to be Reported in PCID 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
If a telecommunications service interruption (toll-free carrier-related or in-house) occurred, the 
MAC shall enter that interruption in PCID between the 1st and the 10th of the month for the 
previous months data.  No reporting is necessary for months in which there were no such 
    interruptions.  See section 30.4.4 of this chapter for information about telecommunications 
service interruptions in general and other required service interruption reporting. 
 
The data to be entered in PCID to report telecommunications service interruptions are as follows: 
 
  Date the telecommunications service interruption occurred. 
  Time of day (local time) the telecommunications service interruption occurred. 
  Date and time of day (local time) the telecommunications issue was resolved. 
  Line of Business affected -- A, B, HH+H, DME, and Other Program Area Application(s) 
Affected  Appeals, EDI, PE. 
  Channel:  Impacted line(s)  IVR-only, CSR-only, combined IVR/CSR. 
  Impacted location -- The PCC call center location impacted. 
  Source -- Internal or External (network service). 
  Overview/Description -- A description of the problem. 
  Resolution -- How the interruption was resolved. 
 
 
80.2.3.8  Provider Internet-based Portal Service Interruptions to be 
Reported in PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
If an Internet-based portal service interruption occurred (for example, the portal was 
unexpectedly down or one or more portal functions were unexpectedly unavailable to portal 
users), the MAC shall enter that interruption into PCID between the 1st and the 10th of the 
previous months data, using the Telecommunications Service Interruptions data entry screen.  
No reporting is necessary for months in which there were no such interruptions. (See section 30 
of this chapter, which requires MACs to report a Contractor Alert at the time of an unexpected 
portal downtime or the unexpected unavailability of a portal function(s) that creates an adverse 
effect on the PCC.) 
 
 The data to be entered in PCID to report Internet-based portal service interruptions are as 
follows: 
 
  Date the Internet-based portal service interruption occurred. 
  Time of day (local time) the Internet-based portal service interruption occurred. 
  Date and time of day (local time) the Internet-based portal issue was resolved. 
  HETS-related (check box) 
  Portal function(s) affected by the service interruption (for example, all functions, ability 
to submit claims, ability to submit an eligibility request and receive an eligibility 
response, etc.).  
  Impacted jurisdiction(s). 
  Source -- Internal or external problem. 
  Overview/Description -- A description of the problem. 
  Resolution -- How the service interruption was resolved. 
   
    80.2.3.9  Provider Internet-based Portal Functionality to be Reported in 
PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall enter current portal functionality in PCID on a monthly basis between the 1st and the 
10th of each month for the previous months data.  MACs shall report portal functionality in the 
Portal Functionality module by selecting the available functionalities from a list.  MACs shall 
also report additional functionalities available but are not in the list.   
 
Additional information is available in PCID documentation. 
 
80.2.3.10  Provider Education Website Analytic Data to be Reported in PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall enter provider education website analytic data in PCID on a monthly basis between 
the 1st and the 10th of each month for the previous months data.  MACs shall report provider 
education website analytic data in the Website Analytics module using the definitions provided 
by CMS.   
MACs shall report the following provider education website analytic data by jurisdiction and by 
line of business (A, B, HH+H, DME): 
 
  Visits (total visits, new visits, return visits, visits via mobile devices, average visit 
duration, bounce rate). 
  Pages (total page views, average page views per visit, top 5 pages viewed most often). 
  Other (number of on-site search queries initiated, top 5 search terms entered by visitors). 
 
Definitions and additional information are available in PCID documentation. 
 
80.2.3.11  Social Media Analytic Data to be Reported in PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
MACs shall enter their social media data on a monthly basis between the 1st and the 10th of each 
month for the previous months data.  MACs shall report their social media data in the Social 
Media module using the definitions provided by CMS. 
 
MACs shall enter their social media channels in PCID under Administration before reporting 
monthly data. MACs shall enter the following data to setup their social media channels in PCID: 
  
  Channel  The type of social media channel: ex. Blog, Facebook, LinkedIn, Twitter, 
YouTube  
  Name  The name of the channel: ex. JX Twitter  
  URL  The URL of the social media channel  
 
MACs shall report the following monthly social media data, by jurisdiction, into PCID:  
  Number of Posts - The number of posts  
      Number of Comments to Posts - The number of comments received on posts  
  Number of Followers - The number of followers to the social media channel  
  Number of Likes - The number of likes to the social media channel  
  Number of Shares/Retweets - The number of times posts were shared by followers  
  Number of Mentions - The number of times the term or phrase you were tracking was 
used across social media 
 
80.2.3.12  Direct Mailing Information to be Reported in PCID 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
Contractors shall report the following information about Direct Mailings into the Special 
Initiatives portion of PCID between the 1st and 10th of the month, following the month of the 
actual completion date: 
  Date completed 
  Number of packages sent 
  Number of providers covered by packages sent 
  Number of packages returned 
  Cost 
 
If MACs need to change the numbers reported in PCID, corrections shall be sent to the PCID 
resource mailbox at pcid@cms.hhs.gov. MACs shall not make multiple entries into PCID 
regarding direct mailings.  
 
MACs shall track and report undeliverable packages for two months after the packages are 
mailed. 
 
80.3 QCM 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS strives to continuously improve Medicare customer satisfaction through the delivery of 
high quality and cost-effective customer service. High quality customer service is convenient and 
accessible, accurate, courteous and professional, and responsive to the needs of diverse groups. 
QCM is a web-based database that is used for accuracy, courtesy and professionalism.  
 
MACs shall complete scorecards and enter data into the QCM the 10th of each month.  See 
section 30.4.12 of this chapter for additional information. 
 
80.3.1 - Access to QCM 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The QCM system is an interactive web-based tool that is password protected and accessible 
only to authorized users.  
 
    MAC staff who need access to the QCM database shall request access by filling out the 
PCSP System User Access Request Form and submitting it to their appropriate Database 
Supervisor or alternate.  Upon the discretion of the Database Supervisor or alternate, the 
Database Supervisor or alternate shall either grant access or deny access to QCM for the 
requesting MAC staff.  The Database Supervisor or alternate may grant access to the same 
person for more than one contract.  The Database Supervisor or alternate shall keep a copy 
of all completed PCSP System User Access Request Forms. All copies of completed PCSP 
System User Access Request Forms shall be made available to CMS upon request.  
If MAC staff no longer needs access to the QCM database, the Database Supervisor or 
alternate shall archive those users in the database.  The Database Supervisor or alternate 
shall review the database monthly to identify and archive MAC staff who no longer need 
access.   
 
The Database Supervisor or alternate shall ensure that all MAC staff who need access to 
QCM, have access within 30 calendar days after the first cutover date.  
 
 
 
 
80.4 QWCM 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
CMS strives to continuously improve Medicare customer satisfaction through the delivery of 
high quality and cost-effective customer service.  High quality customer service is convenient 
and accessible, accurate, courteous and professional, and responsive to the needs of diverse 
groups.  QWCM is the primary way for CMS to assess if Medicare customer service is meeting 
the performance standards established for accuracy, completeness, courtesy, and 
professionalism.  
 
MACs shall complete scorecards and enter data into the QWCM. 
 
80.4.1 - Access to QWCM 
(Rev. 10772, Issued: 04-29-21, Effective: 12-16-20, Implementation: 12-16-20) 
 
The QWCM system is an interactive web-based tool that is password protected and accessible 
only to authorized users.   
 
MAC staff who need access to the QWCM database shall request access by filling out the 
PCSP System User Access Request Form and submitting it to their appropriate Database 
Supervisor or alternate.  Upon the discretion of the Database Supervisor or alternate, the 
Database Supervisor or alternate shall either grant access or deny access to QWCM for the 
requesting MAC staff.  The Database Supervisor or alternate may grant access to the same 
person for more than one contract.  The Database Supervisor or alternate shall keep a copy 
of all completed PCSP System User Access Request Forms. All copies of the completed 
PCSP System User Access Request Forms shall be made available to CMS upon request.  
 
    If MAC staff no longer needs access to the QWCM database, the Database Supervisor or 
alternate shall archive those users in the database. The Database Supervisor or alternate 
shall review the database monthly to identify and archive MAC staff who no longer need 
access.  
 
The Database Supervisor or alternate shall ensure that all MAC staff who need access to 
QWCM, have access within 30 calendar days after the first cutover date.  
 
90 - Disclosure of Information 
(Rev. 10900; Issued:08-11-21; Effective:09-14-21; Implementation:09-14-21) 
 
MACs shall protect the confidentiality of PII and PHI as well as provider PII in accordance with 
the Privacy Act of 1974 and HIPAA.  MACs shall comply with the requirements in the DDR 
prepared and made available by CMS.  The DDR Guide applies to all telephone, written, portal 
and congressional inquiries.  The Disclosure Desk Reference is available in the Documentation 
Section of PCID.  
 
 
 
 
 
 
 
 
 
Transmittals Issued for this Chapter 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
    Rev #  Issue Date  Subject  Impl Date  CR# 
R10900COM  08/11/2021  Updates to Pub. 100-09, Chapter 6 Beneficiary  09/14/2021 12374 
  and Provider Communications Manual, Chapter 6, 
Provider Customer Service Program 
R10772C0M  04/30/2021  Updates to Pub. 100-09, Chapter 6 Beneficiary  12/16/2020 11918 
and Provider Communications Manual, Chapter 6, 
Provider Customer Service Program 
R10519COM  12/15/2020  Updates to Pub. 100-09, Chapter 6 Beneficiary  12/16/2020 11918 
and Provider Communications Manual, Chapter 6, 
Provider Customer Service Program- Rescinded 
and replaced by Transmittal10772 
R10455COM  11/13/2020  Updates to Pub. 100-09, Chapter 6 Beneficiary  12/16/2020 11918 
and Provider Communications Manual, Chapter 6, 
Provider Customer Service Program- Rescinded 
and replaced by Transmittal 10519 
R41COM  02/08/2019  Update to Publication (Pub.) 100-09 to Provide  03/12/2019 11059 
Language-Only Changes for the New Medicare 
Card Project 
R39COM  10/22/2017  Updates to Pub. 100-09, Chapter 6 Beneficiary  10/23/2017 10258 
and Provider Communications Manual, Chapter 6, 
Provider Customer Service Program 
 
R36COM  07/21/2017   Updates to Pub. 100-09, Chapter 6 Beneficiary and  08/22/2017 10168 
Provider Communications Manual, Chapter 6, 
Provider Customer Service Program 
R35COM  10/07/2016  Updates to Pub. 100-09, Beneficiary and Provider  11/08/2016 9682 
Communications Manual, Chapter 6, Provider 
Customer Service Program 
R31COM  02/13/2015  Update of IOM Pub. 100-09, Chapter 6, section  02/20/2015 8995 
30.2.11 to include the requirements for 
implementing Quality Assurance Monitoring at 
the Medicare Administrative Contractors 
R30COM  12/19/2014  Revision of Pub. 100-06 - Medicare Financial  01/23/2015 8906 
Management Manual, Chapter 6 - Intermediary and 
Carrier Financial Reports, and Pub. 100-09 - 
Medicare Contractor Beneficiary and Provider 
Communications, Chapter 6 - Provider Customer 
Service Program 
    R29COM  06/27/2014  Revision of Pub. 100-09, Chapter 6, Medicare  07/02/2014 8491 
Contractor Beneficiary and Provider 
Communications Manual; Clearance of MAC 
Internet-Based Provider Portal Handbook; and 
Deletion of IOM Pub. 100-09, Chapter 3, Provider 
Inquiries 
R28COM  05/02/2014  Revision of Pub. 100-09, Chapter 6, Medicare  07/02/2014 8491 
Contractor Beneficiary and Provider 
Communications Manual; Clearance of MAC 
Internet-Based Provider Portal Handbook; and 
Deletion of IOM Pub. 100-09, Chapter 3, Provider 
Inquiries  Rescinded and replaced by Transmittal 
29 
R27COM  03/12/2010  Change in Provider Customer Service Program  04/12/2010 6817 
Requirements 
R26COM  08/07/2009  Provider Customer Service Program Updates  09/08/2009 6482 
R25COM  03/04/2009  Implementation of the New Provider  01/05/2009 6139 
Authentication Requirements for Medicare 
Contractor Provider Telephone and Written 
Inquiries 
R24COM  02/25/2009  Implementation of the New Provider  01/05/2009 6139 
Authentication Requirements for Medicare 
Contractor Provider Telephone and Written 
Inquiries - Rescinded and replaced by Transmittal 
25 
R23COM  02/10/2009  Implementation of the New Provider  04/06/2009 6139 
Authentication Requirements for Medicare 
Contractor Provider Telephone and Written 
Inquiries - Rescinded and replaced by Transmittal 
24 
R22COM  08/08/2008  Implementation of the New Provider  01/05/2009 6139 
Authentication Requirements for Medicare 
Contractor Provider Telephone and Written 
Inquiries  Rescinded and replaced by Transmittal 
23 
R21COM  01/11/2008  Instructions Related to the CMS Standardized  02/11/2008 5848 
Provider Inquiry Chart for FY2008 
R20COM  07/13/2007  IOM Pub. 100-09, Chapters 3- Provider Inquiries  07/30/2007 5597 
and Chapter 6- Provider Customer Service 
Program Updates 
R19COM  06/29/2007  IOM Pub. 100-09, Chapters 3- Provider Inquiries  07/30/2007 5597 
and Chapter 6- Provider Customer Service 
Program Updates - Replaced by Transmittal 20 
    R18COM  09/08/2006  Provider Customer Service Program  10/02/2006 5277 
R16COM  07/21/2006  Disclosure Desk Reference for Provider Contact  10/02/2006 5089 
Centers 
R15COM  11/18/2005  Initial Issuance of Chapter  12/19/2005 4137 
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