Failure to Submit Requested Data/Documentation / Paper Applications / Internet-Based PECOS Applications

Failure to Submit Requested Data/Documentation

The instructions in sections 15.7.1.6.1 and 15.7.1.6.2:

• Apply unless another CMS directive or instruction states otherwise.

• Are subject to the processing alternatives identified in sections 15.7.1.3.1 through 15.7.1.3.4 of this chapter.

Paper Applications

If, in the contractor’s view, the provider failed to submit all of the requested data/documentation and/or a valid certification statement (either as a correction to the original certification statement or as part of a request for missing data), the contractor may:

• Reject the application if the 30-day period has elapsed,

• Wait until the 30-day period has elapsed and then reject the application, or

• Make a second request for the outstanding missing/clarifying data/documentation and/or an appropriate certification statement. (The request can be made via mail, fax, or e-mail. If the request is sent via e-mail, it need not be in the form of a letter.) The contractor may establish its own deadline for the provider’s submission of the remaining data or the certification statement, though it must be at least 7 business days from the date of this second request. In making the request, the contractor must specify: (1) the date of the original request/development letter and the material that was requested therein; (2) the data that is still missing or must be clarified; (3) that a newlysigned certification statement is necessary if the data must be furnished on the Form CMS-855; (4) the deadline for submission; (5) the address, fax number, and e-mail address to which the data/certification statement can be sent; and (6) the name, phone number, and e-mail address of an appropriate contact person at the contractor site.)

While the contractor is not required to make a second request if the provider fails to timely and fully respond to the development letter, the contractor is encouraged to make an additional request if: (1) it appears that the provider is making a good-faith effort to comply with the development letter and/or (2) the provider furnished most of the requested data. For instance, suppose the contractor requested 5 pieces of missing information. The contractor timely submitted 4 of them and furnished a signed (though undated) certification statement. Since the provider appears to be acting in good faith, the contractor is encouraged to continue working with the provider.

If the provider fails to fully respond to a second request, the contractor may either: (1) reject the application if the original 30-day period has elapsed, (2) wait until the 30-day period has elapsed and then reject the application, or (3) make a third request using the procedures described above.

 Internet-Based PECOS Applications

If, in the contractor’s view, the provider failed to submit all of the requested data/documentation and/or failed to submit a valid certification statement (either as a correction to the original certification statement or as part of a request for missing data), the contractor may:

• Reject the application if the 30-day period has elapsed,

• Wait until the 30-day period has elapsed and then reject the application, or

• Make a second request for the outstanding missing/clarifying data/documentation and/or an appropriate certification statement. (The request shall be made via PECOS e-mail.) The contractor can establish its own deadline for the provider’s submission of the remaining data, though it must be at least 7 business days from the date of the request. In making the request, the contractor shall specify: (1) the date of the original development e-mail and the material that was requested therein; (2) the data that is still missing or needs to be clarified; (3) that a newly-signed certification statement (either via Internet-based PECOS or paper) is necessary if the data must be furnished on the Form CMS-855; (4) the deadline for submission; (5) the address, fax number, and e-mail address to which the documentation or certification statement can be sent (though the provider should be encouraged to use e-signature and the DDR); and (6) the name, phone number, and e-mail address of an appropriate contact person at the contractor site.

While the contractor is not required to make a second request if the provider fails to timely and fully respond to the development letter, the contractor is encouraged to make an additional request if: (1) it appears that the provider is making a good-faith effort to comply with the development letter and/or (2) the provider furnished most of the requested data.

If the provider fails to fully respond to a second request, the contractor may either: (1) reject the application if the original 30-day period has elapsed, (2) wait until the 30-day period has elapsed and then reject the application, or (3) make a third request using the procedures described above.