System and Processing Requirements for Use of Secure Internet

310.10 - System and Processing Requirements for Use of Secure Internet Portal/Application to Support Appeals Activities (Rev. 4380, Issued: 08-30-19, Effective: 07-08-19, Implementation: 10- 01-19) MACs who develop and utilize a secure Internet portal/application for appeals purposes shall ensure, at a minimum: • CMS approves (i.e., contract manager or project officer, if applicable) the proposed portal/application and usage prior to development and implementation. • The portal/application fully complies with and has been tested to ensure compliance with all CMS system security requirements regarding protected health information prior to implementation/usage. • The secure Internet portal/application includes a formal registration process that validates the identity of appellants using the portal. This process shall include, at a minimum, use of restricted user identities and passwords. A/B MACs (A), (B), (HHH), and DME MACs shall include an indication and/or description of the validation methodology in the appeals case file should a higher level of appeal be submitted. • Templates for submission of electronic appeal requests shall include, at a minimum, a method for authenticating that the appellant has completed the portal/application registration process and has been properly identified by the system as an appropriate user. • All MACs utilizing an approved portal/application shall provide education to appellants regarding system capabilities/limitations prior to implementation and utilization of the secure portal/application. • MACs shall also educate appellants that participation/enrollment in the secure portal/application is at the discretion of the appellant and the appellant bears the responsibility for the authenticity of the information being attested to. • Appropriate procedures are in place to provide appellants with confirmation of receipt of the appeal request via secure Internet/portal and verbiage instructing the appellant not to submit additional redetermination requests for the same item or service via different venue (hard copy mail or facsimile). This information is necessary to discourage appellants from submitting multiple appeal requests for the same item/service through the same or multiple venues (i.e., filed via secure Internet portal/application and at a later date via mail). • MACs utilizing a secure portal/application shall ensure that there is a process in place by which an appellant can submit additional documentation/materials concurrent with the appeal request so as not to cause a delay in the timely processing of the appeal. The portal/application shall have the capability to accept additional documentation and/or other materials to support appeal requests. • Redetermination decisions and/or dismissal notices transmitted via a secure Internet portal/application shall comply with the timeliness and content requirements as outlined in the IOM Pub. 100-04, Medicare Claims Processing Manual, chapter 29, unless otherwise noted above. In addition, MACs shall provide hard copy decision and/or dismissal notices to parties to the appeal who do not have access to the secure Internet portal/application. The notices must be mailed and/or otherwise transmitted concurrently (i.e., mailed on the same day the notice is transmitted via the secure portal/application). • MACs shall also ensure that appellants may save and print the decision or dismissal notice and that the secure portal/application includes a mechanism by which the date/time of the notification is tracked/marked both in the system and on any printed decision or dismissal notices so as to adequately inform the appellant of timeframes for ensuring timely submission of future appeal requests. • If the MAC receives a request for a case file from the QIC, the MAC shall provide the complete case file including a decision or dismissal notice regardless of whether the appeal was processed via a secure Internet portal/application.