Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 310.6.3

Processing Requests to Vacate Dismissals

Last amended: 2019Year: 2019Length: 450 wordsOfficial source
310.6.3 – Processing Requests to Vacate Dismissals (Rev. 4380, Issued: 08-30-19, Effective: 07-08-19, Implementation: 10- 01-19) If a party submits a request to vacate the dismissal, and the request contains sufficient evidence or other documentation that supports a finding of good cause for late filing, the MAC makes a favorable good cause determination. Where a finding for good cause is made, the MAC shall document the reason for that finding in the appeal decision letter, the appeal case file, or both. Once it makes a favorable good cause determination, it considers the appeal to be timely filed, vacates its prior dismissal action, and performs a redetermination. For the purposes of counting workload in CROWD and in the MAS, a determination to vacate a dismissal should be counted as a redetermination and not a reopening. If the MAC does not find good cause to vacate the dismissal, the dismissal remains in effect. The MAC issues a letter (not a dismissal letter) explaining that good cause has not been established and the dismissal cannot be vacated. Although the appellant may not appeal a MAC’s finding that good cause was not established when the appellant requested that the MAC vacate its dismissal, the appellant maintains their right to request a QIC review of the MAC’s dismissal action. However, requests for QIC review of a MAC’s dismissal action must be received by the QIC within 60 days of the date of receipt of the dismissal notice. For purposes of counting workload in CROWD and in the MAS, a MAC’s determination not to vacate a dismissal action is counted as an inquiry, not as a dismissal action. If an appellant requests that the MAC vacate the dismissal action, and the MAC determines that that it cannot vacate the dismissal, the MAC sends a letter notifying the appellant. The MAC shall not issue a second dismissal notice to the appellant since a dismissal should only be issued in response to an appeal request. A request to vacate a dismissal is not a request for an appeal. If the contractor determines that the request to vacate the dismissal of the redetermination request does not provide good and sufficient cause to vacate, the contractor shall respond with a letter that addresses why the request to vacate does not meet the criteria for good cause. Any evidence or information not previously submitted with the redetermination request that is submitted with the request to vacate the dismissal shall be addressed by the contractor in their letter. The contractor must explain in clear language why all evidence and information submitted, including what was sent with the request to vacate the dismissal, does not meet the requirement necessary to vacate the dismissal.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 310.6.3: Processing Requests to Vacate Dismissals | Justis AI