Requesting to Pay Claims Outside of CWF

60.1 - Requesting to Pay Claims Outside of CWF (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) A/B MACs or DME MACs may also request approval from CMS in specific situations to pay claims without CWF approval. Examples of such situations are: • Other A/B MACs or DME MACs cannot complete action to remove an impediment that blocks a contractor from processing of a claim; and/or • A systems error cannot be corrected timely, and the provider's cash flow will be seriously endangered. • Administrative Law Judge (ALJ) decisions, court decisions, and CMS instructions in particular cases may necessitate that payment be made outside the normal CWF process. A/B MACs or DME MACs shall obtain approval from CMS to pay a claim without CWF approval prior to processing that claim outside the CWF/CWF system. A/B MACs and DME MACs shall submit a written request to their CMS Contracting Officer Representative (COR) for approval to make payment without CWF approval. Such requests shall be submitted by facsimile transmission or via the Internet. To ensure the protection of the Personal Health Information (PHI) and Personally Identifiable Information (PII) contained in contractor requests to pay claims without CWF approval, contractors shall encrypt their E-mail submitted requests. A/B MACs or DME MACs shall provide the following information to their CMS COR when requesting to pay a claim without CWF approval: a) A/B MAC or DME MAC’s Internal Claim Control Number, b) Medicare beneficiary identifier, c) Beneficiary Name, d) Provider Number (National Provider Identification (NPI) Number), e) From and To Date of Service, f) Procedure Code(s), g) Total Charges, h) Amount to be Paid, i) CWF Error Code/Condition Preventing Payment (including error code definition), and j) Rationale for Paying the Claim Outside the CWF/CWF System.